Park Ji Hun, Park Geun Woo, Choi In Cheul, Kwon Young Woo, Park Jong Woong
Department of Orthopaedic Surgery, Korea University Guro Hospital, Seoul, South Korea.
Department of Orthopaedic Surgery, Korea University Anam Hospital, 73, Inchon-ro, Sungbuk-gu, Seoul, 06334, South Korea.
Arch Orthop Trauma Surg. 2019 Jan;139(1):141-145. doi: 10.1007/s00402-018-3074-y. Epub 2018 Nov 23.
An articular depressed fragment at the base of the middle phalanx can be an obstacle to congruent reduction and stable fixation. This study assessed the outcomes of a transosseous reduction technique combined with locking plate fixation for the treatment of articular depressed middle phalangeal base fracture.
Between 2015 and 2017, seven patients (eight fingers) with intraarticular comminuted middle phalangeal base fracture were included in this study. Mean follow-up was 19 months (range 12-30 months). All patients showed depression of the articular fragment on sagittal computed tomography (CT) scan and were treated with a transosseous reduction technique and dorsal locking plate fixation. Radiographic evaluation was performed to ensure restoration of a concentric articular surface postoperatively. Total active range of motion (TAM) of the finger, grip strength, and the quick Disabilities of the Arm, Shoulder and Hand (quick DASH) score were evaluated at the last follow-up. Complications were also assessed.
All fractures obtained bony union with a concentric joint. There was no significant loss of reduction during the follow-up period. The mean active proximal interphalangeal (PIP) joint and distal interphalangeal joint motion arcs at follow-up were 89° and 61°, respectively. Mean TAM of the affected finger and mean grip strength were 94% (range 80-100%) and 94% (range 86-100%) of the contralateral side, respectively. Mean quick DASH score was 2.3 (range 0-9.1). All patients returned to work. No surgery-related complications occurred.
This technique provides satisfactory restoration of articular congruence and enables the early joint mobilization of articular depression-type fractures of the base of the middle phalanx.
TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic, level IV.
中节指骨基底的关节面塌陷骨折块可能会阻碍骨折的解剖复位和稳定固定。本研究评估了经骨复位技术联合锁定钢板固定治疗中节指骨基底关节面塌陷骨折的疗效。
2015年至2017年，本研究纳入了7例（8指）中节指骨基底关节内粉碎性骨折患者。平均随访时间为19个月（范围12 - 30个月）。所有患者在矢状面计算机断层扫描（CT）上均显示关节骨折块塌陷，并采用经骨复位技术和背侧锁定钢板固定治疗。进行影像学评估以确保术后关节面恢复同心。在末次随访时评估手指的总主动活动范围（TAM）、握力以及上肢、肩部和手部功能障碍快速评分（quick DASH）。同时评估并发症情况。
所有骨折均实现了骨愈合且关节同心。随访期间复位无明显丢失。随访时平均近端指间关节（PIP）和远端指间关节的活动弧度分别为89°和61°。患指的平均TAM和平均握力分别为对侧的94%（范围80 - 100%）和94%（范围86 - 100%）。平均quick DASH评分为2.3（范围0 - 9.1）。所有患者均恢复工作。未发生与手术相关的并发症。
该技术能令人满意地恢复关节面的一致性，并能使中节指骨基底关节面塌陷型骨折早期进行关节活动。
研究类型/证据水平：治疗性研究，IV级。
