Department of Orthopaedic Surgery, Washington University School of Medicine, Saint Louis, MO.
Department of Orthopaedic Surgery, Washington University School of Medicine, Saint Louis, MO.
J Hand Surg Am. 2022 Jul;47(7):694.e1-694.e4. doi: 10.1016/j.jhsa.2022.03.020. Epub 2022 May 18.
Metacarpal nonunion is a rare outcome of metacarpal injury, and little has been published about its management. Care typically includes open reduction and internal fixation with a possible bone graft, similar to the treatment of other nonunions. However, there is no literature guidance if traditional methods do not lead to union. To improve the treatment of these recalcitrant metacarpal diaphyseal nonunions, we proposed a new surgical technique using a "top hat" bone graft harvested from the iliac crest. The graft is carefully shaped to create a cancellous "crown," which is inserted into the nonunion site, and cortical "brims," which are used to secure the graft to the metacarpal. This has been successful in treating 2 cases of metacarpal nonunion that failed to heal with first-line intervention.
掌骨骨不连是掌骨损伤的罕见后果，关于其治疗方法的文献报道很少。治疗方法通常包括切开复位内固定和可能的植骨，类似于其他骨不连的治疗。然而，如果传统方法不能导致愈合，目前尚没有文献指导。为了改善这些难治性掌骨干骨不连的治疗效果，我们提出了一种新的手术技术，使用从髂嵴采集的“礼帽”状骨移植物。精心塑造移植物以形成松质“冠”，将其插入骨不连部位，并用皮质“帽檐”将其固定在掌骨上。该技术已成功治疗 2 例经一线干预治疗失败的掌骨骨不连。
