Tan Mark, Ho Sean Wei Loong, Sechachalam Sreedharan
Department of Orthopaedic Surgery, Tan Tock Seng Hospital, Singapore, Singapore.
J Hand Microsurg. 2018 Apr;10(1):1-5. doi: 10.1055/s-0037-1608691. Epub 2017 Nov 29.
Trauma resulting in severe comminution, bone loss, and articular involvement of the fingers is a challenging injury. Osteosynthesis of the digits is nonviable when there is an inability to restore a stable articular surface adequately. Acute arthrodesis of the proximal and distal interphalangeal joints may be an option in such scenarios. The aim of this study is to evaluate the role of finger joint arthrodesis in the setting of trauma, in terms of fusion rates and clinical outcomes.
Patients with injuries treated via acute finger arthrodesis between 2010 and 2012 at a single institution were retrospectively reviewed. Complete finger amputations requiring replantation were excluded. Finger arthrodesis was performed acutely via intraosseous cerclage wires, Kirschner wires, or tension band wiring. Fusion rates were determined by plain radiography, and clinical outcomes were assessed with the Disabilities of the Arm, Shoulder and Hand (DASH) score.
A total of 11 patients were recruited. All patients were males with an average age of 35.3 years (range: 21-63 years). None of the cases involved the thumb, and there was an equal distribution of injury amongst the fingers. Nine of the 11 patients involved the distal interphalangeal joint with the remaining involving the proximal interphalangeal joint. Radiologic union was achieved in 9 out of 11 patients, and the average time to fusion was 75.5 days. The average DASH score for the patients was 16.5 (10.8-22.5). All patients were able to return to their premorbid occupation, with average time to return to work of 104.3 days (59-168 days). There were no cases of infection or reoperation.
We propose that posttraumatic acute arthrodesis of the finger joints is a viable treatment in situations in which there is difficulty in restoring the articular congruity, with early return to work and good function.
导致手指严重粉碎性骨折、骨缺损及关节受累的创伤是一种具有挑战性的损伤。当无法充分恢复稳定的关节面时，手指的骨内固定是不可行的。在这种情况下，近端和远端指间关节的急性关节融合术可能是一种选择。本研究的目的是从融合率和临床结果方面评估手指关节融合术在创伤情况下的作用。
回顾性分析2010年至2012年在单一机构接受急性手指关节融合术治疗的患者。排除需要再植的完全性手指离断伤。通过骨内环扎钢丝、克氏针或张力带钢丝进行急性手指关节融合术。通过X线平片确定融合率，并用手臂、肩部和手部功能障碍（DASH）评分评估临床结果。
共纳入11例患者。所有患者均为男性，平均年龄35.3岁（范围：21 - 63岁）。所有病例均未累及拇指，各手指损伤分布均匀。11例患者中有9例累及远端指间关节，其余累及近端指间关节。11例患者中有9例实现了影像学骨愈合，平均融合时间为75.5天。患者的平均DASH评分为16.5（10.8 - 22.5）。所有患者均能够恢复到病前的工作，平均恢复工作时间为104.3天（59 - 168天）。没有感染或再次手术的病例。
我们认为，创伤后手指关节的急性关节融合术在难以恢复关节一致性的情况下是一种可行的治疗方法，患者可早期恢复工作且功能良好。
