Liodaki Eirini, Kisch Tobias, Wenzel Eike, Mailänder Peter, Stang Felix
Department of Plastic Surgery, Hand Surgery and Burn Care Unit, University Hospital Schleswig-Holstein, Campus Lübeck, Lübeck, Germany.
Eplasty. 2017 Feb 24;17:e8. eCollection 2017.
Fractures of metacarpals and phalanges are very common fractures, and there are a lot of treatment modalities. The purpose of the study was to describe the technique of percutaneous fixation of phalangeal fractures using a cannulated compression screw fixation system and its results. We conducted a prospective clinical study on 43 patients with different types of phalangeal fractures undergoing a percutaneous cannulated compression screw osteosynthesis. Parameters such as average operation time and clinical outcome were evaluated postoperatively. Forty-three patients were treated using a percutaneous cannulated compression screw fixation system for phalanx fractures of the proximal (n = 26), middle phalanx (n = 16), or distal phalanx (n = 1). All fractures healed after 6 to 8 weeks except in 1 patient with secondary loss of reduction occurring 2.5 weeks after surgery. No infections were observed. The mean total active motion values were 247.56° ±16.16° and 244.35° ± 11.61° for the intra-articular fracture and 251.25° ± 19.86° for the shaft fractures; the mean Disabilities of the Arm, Shoulder, and Hand (DASH) score 3 months after the surgery was 1.67 ± 2.74. The advantages of this technique are the avoidance of an open procedure requiring extensive soft-tissue dissection with the risks of tendon adhesions and the achievement of interfragmentary compression. Because of the interfragmentary compression, it is superior to simple K-wires. With regard to indications, our primary focus was on unicondylar proximal interphalangeal joint fractures, shaft fractures, and simple oblique 2-fragment fractures.
掌骨和指骨骨折是非常常见的骨折，治疗方式众多。本研究的目的是描述使用空心加压螺钉固定系统经皮固定指骨骨折的技术及其结果。我们对43例不同类型指骨骨折患者进行了前瞻性临床研究，采用经皮空心加压螺钉接骨术。术后评估平均手术时间和临床结果等参数。43例患者采用经皮空心加压螺钉固定系统治疗近端指骨骨折（n = 26）、中指骨骨折（n = 16）或远端指骨骨折（n = 1）。除1例患者术后2.5周出现继发性复位丢失外，所有骨折均在6至8周后愈合。未观察到感染情况。关节内骨折的平均总主动活动度值为247.56°±16.16°，骨干骨折为244.35°±11.61°；术后3个月的平均上肢、肩部和手部功能障碍（DASH）评分为1.67±2.74。该技术的优点是避免了需要广泛软组织剥离的开放手术及其肌腱粘连风险，并实现了骨折块间加压。由于骨折块间加压，它优于单纯克氏针。关于适应证，我们主要关注单髁近端指间关节骨折、骨干骨折和简单斜行两骨折块骨折。
