Finsen Vilhjalmur
Department of Orthopaedic Surgery, St. Olav's University Hospital, and Department of Neuroscience, Faculty of Medicine, NTNU, Trondheim, Norway.
J Plast Surg Hand Surg. 2010 Nov;44(4-5):209-13. doi: 10.3109/02844311.2010.494416.
Basal fractures of the middle phalanx are uncommon, but difficult to treat. We have reviewed our first 20 patients using the Suzuki pins and rubber traction who were treated during an 8.5 year period (June 1998-December 2006) and 18 who were reviewed after 49 (range 17-116) months. All injuries were closed fractures of the base of the middle phalanx. Ten patients had a fracture of the volar lip and dorsal subluxation of the phalanx, one had a fracture of the dorsal lip, and seven had comminuted pilon fractures. Median operating time was 33 (18-255) minutes. Thick "vessel loops" were often used for traction, and active movement before the traction was removed after 38 (8-46) days was disappointing. There were two superficial infections and one deep. One proximal interphalangeal (PIP) joint had been treated by arthrodesis and another amputated before review. On a visual analogue scale (VAS) from 0 (best) to 10 (worst), patients at review reported discomfort when wearing the traction as 5.5 (0-10), pain as 0 (0-6), and finger function as 3 (0-6). The median Quick-DASH score (100 = worst) was 2 (0-48) and grip strength 97 (75-118) % of the other hand. Median extension, flexion, and total range of movement of the PIP joint in 16 fingers were -9°, 83°, and 72°, respectively. Our results are no more than adequate. They might have been better if the force of traction had been less by using rubber bands instead of vessel loops, if postoperative follow-up had been more frequent allowing for correction of traction when necessary, and if traction had been discontinued earlier.
中节指骨基底部骨折并不常见，但治疗困难。我们回顾了在8.5年期间（1998年6月至2006年12月）使用铃木针和橡胶牵引治疗的前20例患者，以及49（17 - 116）个月后接受复查的18例患者。所有损伤均为中节指骨基底部闭合性骨折。10例患者为掌侧唇骨折伴指骨背侧半脱位，1例为背侧唇骨折，7例为粉碎性pilon骨折。中位手术时间为33（18 - 255）分钟。常使用粗“血管袢”进行牵引，38（8 - 46）天后去除牵引前的主动活动效果不佳。有2例浅表感染和1例深部感染。1例近端指间（PIP）关节已行关节融合术治疗，另1例在复查前已截肢。在0（最佳）至10（最差）的视觉模拟量表（VAS）上，复查时患者报告佩戴牵引时的不适为5.5（0 - 10），疼痛为0（0 - 6），手指功能为3（0 - 6）。中位Quick - DASH评分（100 =最差）为2（0 - 48），握力为对侧手的97（75 - 118）%。16根手指的PIP关节中位伸展、屈曲和总活动范围分别为 - 9°、83°和72°。我们的结果仅为尚可。如果使用橡皮筋而非血管袢减少牵引力量，如果术后随访更频繁以便在必要时校正牵引，如果更早停止牵引，结果可能会更好。
