Thirumalai Andal, Mikalef Petros, Jose Rajive Mathew
From the *Department of Plastic and Hand Surgery, Queen Elizabeth Hospital, Birmingham; and †Department of Orthopaedics, Royal South Hants Hospital, Southampton, United Kingdom.
Ann Plast Surg. 2017 Sep;79(3):270-274. doi: 10.1097/SAP.0000000000001119.
Avulsion fractures can pose technical difficulties for surgical fixation. The fragments are often small and around finger joints with access being difficult due to attachment of ligaments or tendons. Traditionally, these have been treated using K wires, lag screws, or pullout sutures.Hook plates were originally described for operative management of mallet fractures. We have been using hook plates in our unit for over 10 years. However, over the years, we have extended their use to other avulsion fractures in the hand such as proximal interphalangeal joint fracture dislocations, central slip avulsions, flexor digitorum profundus avulsions and collateral ligament avulsions.The aim of this article is to describe the technique of fabricating a hook plate and using it for avulsion fractures in the hand. A few illustrative cases are discussed along with a review of the current literature.
In a retrospective review of our use of hook plates in hand fractures from 2008 to 2014, a total of 63 cases were identified from the hospital data base. There were 35 cases of Mallet fractures, 16 cases of proximal interphalangeal joint fracture dislocations, 5 cases of flexor digitorum profundus avulsion fractures, 5 cases of Central slip avulsions, and 2 collateral ligament avulsions.
All fractures healed well with this technique with no biomechanical failures and good functional outcome. Plates needed removal in a total of 25 cases, of which 14 were in mallet fractures. Thirteen (21%) cases suffered complications, of which the majority were again related to mallet fractures.
The hook plate is a simple device that can be created quite easily with readily available materials. We have extended the use of these plates to avulsion fracture fixation in the hand and found this to be a versatile technique. The risk of fragmenting the small fracture fragment is reduced because the hooks secure it and the plate is fixed in the bone. If done meticulously, joint congruence can be achieved. It has a biomechanical advantage over current methods of fracture fixation of small but important bone fragments in the hand.
撕脱性骨折会给手术固定带来技术难题。骨折碎片通常较小，且位于手指关节周围，由于韧带或肌腱的附着，手术入路困难。传统上，这些骨折采用克氏针、拉力螺钉或抽出缝线进行治疗。钩钢板最初用于槌状指骨折的手术治疗。我们科室使用钩钢板已有10多年。然而，多年来，我们已将其应用扩展至手部的其他撕脱性骨折，如近端指间关节骨折脱位、中央束撕脱、指深屈肌撕脱和侧副韧带撕脱。本文旨在描述钩钢板的制作技术及其在手部撕脱性骨折中的应用。文中讨论了一些说明性病例，并对当前文献进行了综述。
回顾性分析我们在2008年至2014年期间对手部骨折使用钩钢板的情况，从医院数据库中总共识别出63例病例。其中槌状指骨折35例，近端指间关节骨折脱位16例，指深屈肌撕脱骨折5例，中央束撕脱5例，侧副韧带撕脱2例。
采用该技术所有骨折均愈合良好，无生物力学失败情况，功能结果良好。总共25例需要取出钢板，其中14例为槌状指骨折。13例（21%）出现并发症，其中大多数仍与槌状指骨折有关。
钩钢板是一种简单的装置，用现成的材料很容易制作。我们已将这些钢板的应用扩展至手部撕脱性骨折的固定，并发现这是一种通用技术。由于钩子固定小骨折碎片且钢板固定于骨内，小骨折碎片碎裂的风险降低。如果操作细致，可以实现关节对位。与目前手部小而重要骨碎片骨折固定方法相比，它具有生物力学优势。
