Department of Hand Surgery, SOS hand, University Hospital of Strasbourg, FMTS, Icube CNRS 7357, University of Strasbourg, 1 avenue Molière, 67000, Strasbourg, France.
Department of Surgery (Spine), Dalhousie University, QEII Health Sciences Centre - Halifax Infirmary, 1796 Summer Street, Halifax, NS, B3H 3A7, Canada.
Eur J Orthop Surg Traumatol. 2020 Apr;30(3):425-433. doi: 10.1007/s00590-019-02587-0. Epub 2019 Oct 30.
The purpose of this study was to develop a technique allowing a faster return to previous activities after surgical treatment of short transverse and oblique fractures of the diaphysis of the fifth metacarpal. It consisted of an anterograde and retrograde centromedullary double pinning connected. Our series included 40 patients of average age 25 years including 2 women. In 20 cases (group I), an anterograde centromedullary pinning with a 1.6- or 2-mm pin was performed followed by a 6-week orthosis and then 2-week self-education. In 20 cases (group II), an anterograde and retrograde centromedullary double pinning was performed using 2 1.5-mm pins connected by a connector (MétaHUS, Arex™). A first pin was introduced into the canal antegrade, then the second retrograde. The 2 externalized pins were connected, and self-rehabilitation was encouraged. Mean tourniquet time was 14.75 min (group I) and 15.8 min (group II), respectively. At the last follow-up, the average pain was 0.35/10 and 0.2/10, the Quick DASH 0.68/100 and 0.57/100, the strength of the hand 94.65% and 94.35%, the active flexion MCP 98.5% and 99%, respectively. MCP active extension was 98.5% and 98.75%; the sick leave was 8.4 and 6.3 weeks. All fractures healed without recovery with 3 complications: 2 infections on pins, in each group, 1 CRPS1 (group I). Our results seem to show that the technique of anterograde and retrograde centromedullary double pinning connected in the treatment of short transverse and oblique fractures of the diaphysis of the fifth metacarpal gives results at least as good as the reference technique with a non-negligible socioeconomic advantage, a less time off work.
本研究的目的是开发一种技术，使第五掌骨干短斜形和横行骨折患者术后更快地恢复到术前活动状态。该技术包括顺行和逆行髓内双针固定连接。我们的系列研究包括 40 例患者，平均年龄 25 岁，其中包括 2 名女性。在 20 例（I 组）中，行顺行髓内针固定术，使用 1.6 或 2mm 克氏针，术后佩戴支具 6 周，然后进行 2 周的自我教育。在 20 例（II 组）中，使用 2 根 1.5mm 克氏针（MétaHUS，Arex™）进行顺行和逆行髓内双针固定。先将第一根针顺行插入髓腔，然后逆行插入第二根针。将 2 根外露的针连接起来，并鼓励进行自我康复。平均止血带时间分别为 I 组 14.75 分钟和 II 组 15.8 分钟。末次随访时，平均疼痛评分为 I 组 0.35/10 和 II 组 0.2/10，Quick DASH 评分为 I 组 0.68/100 和 II 组 0.57/100，手的握力为 I 组 94.65%和 II 组 94.35%，掌指关节（MCP）主动屈曲为 I 组 98.5%和 II 组 99%，MCP 主动伸展为 I 组 98.5%和 II 组 98.75%；病假分别为 I 组 8.4 周和 II 组 6.3 周。所有骨折均愈合，无并发症，仅 3 例出现并发症：I 组各 1 例针道感染，1 例复杂性区域疼痛综合征（CRPS）1 型。我们的结果似乎表明，顺行和逆行髓内双针固定连接技术治疗第五掌骨干短斜形和横行骨折的效果至少与参考技术一样好，具有不可忽视的社会经济效益，病假时间更短。
