Nishimura Reiji, Wright Lauren, Seitz William H
Department of Plastic and Reconstructive Surgery, The Jikei University School of Medicine, Nishi-Shimbashi, Minato, Tokyo, Japan.
Department of Plastic and Reconstructive Surgery, Cleveland Clinic-South Pointe Hospital, Warrensville Heights.
Tech Hand Up Extrem Surg. 2019 Jun;23(2):84-87. doi: 10.1097/BTH.0000000000000223.
Ulnar-sided carpometacarpal (CMC) joint fracture dislocations are relatively uncommon, frequently associated with fractures of the metacarpal base and/or hamate, and often sustained by young male individuals secondary to striking a hard object. The complexity of ulnar-sided CMC fracture dislocations necessitates careful restitution of anatomic alignment and joint congruency for mobility and stability. Miniaturization of the external fixation device has allowed application to the hand. Spanning external fixation utilizes the principles of "ligamentotaxis"-indirect reduction through distraction forces of capsule-ligamentous structures. Treatment options for ulnar-sided CMC fracture dislocations are varied. Our surgical technique involving an external fixation device is reviewed. Clinical and chart review was performed on the last 10 patients undergoing acute surgical repair of ulnar-sided CMC fracture dislocations with intra-articular comminution by the senior author. Surgical technique used percutaneous Kirschner wire fixation and a spanning, miniature, external fixation device. Minimal follow-up was 1 year. Radiographs from the most recent appointment were evaluated by 2 independent reviewers. Patients rated their level of pain and assessed function using a subjective outcome instrument. Mean total active motion, when comparing traumatized digit to same digit in contralateral hand, was 100%. All fractures healed primarily with maintenance of congruent joint space and without radiographic displacement or arthrosis. Patient satisfaction was high and all patients returned to preinjury level of function. Our study demonstrates the use of an external fixation device in the management of ulnar-sided CMC fracture dislocations to be effective in reestablishing and maintaining normal hand anatomy, reducing pain, increasing function, and preserving motion.
尺侧腕掌关节（CMC）骨折脱位相对少见，常与掌骨基底和/或钩骨骨折相关，且多发生于年轻男性，通常是因击打硬物所致。尺侧CMC骨折脱位的复杂性要求仔细恢复解剖对位和关节一致性，以确保活动度和稳定性。外固定装置的小型化使其能够应用于手部。跨关节外固定利用“韧带牵引”原理——通过关节囊韧带结构的牵张力进行间接复位。尺侧CMC骨折脱位的治疗选择多种多样。本文回顾了我们采用外固定装置的手术技术。资深作者对最近10例接受急性手术修复的尺侧CMC骨折脱位伴关节内粉碎的患者进行了临床和病历回顾。手术技术采用经皮克氏针固定和跨关节微型外固定装置。最短随访时间为1年。由2名独立 reviewers 对最近一次就诊时的X线片进行评估。患者使用主观结果工具对疼痛程度和功能进行评分。将患指与对侧手同一手指相比，平均总主动活动度为100%。所有骨折均一期愈合，关节间隙保持一致，无影像学移位或关节病。患者满意度较高，所有患者均恢复到伤前的功能水平。我们的研究表明，使用外固定装置治疗尺侧CMC骨折脱位在重建和维持手部正常解剖结构、减轻疼痛、增加功能和保留活动度方面是有效的。
