Korkmaz Oguzhan, Abourdan Joud, Birinci Murat, Bostanci Bilal, Kara Adnan
Department of Orthopedics and Traumatology, Istanbul Medipol University, Istanbul, Turkey.
Department of Orthopedics and Traumatology, Istanbul Medipol University, A Medical Student in the Medical Faculty, Istanbul, Turkey.
J Orthop Case Rep. 2022 Dec;12(12):43-49. doi: 10.13107/jocr.2022.v12.i12.3458.
Metacarpal bone fractures often lead to significant shortening in the phalanges; it can be caused by variable conditions, ranging from idiopathic, and infective to traumatic causes. There are very rare reports of metacarpals shortening in idiopathic primary hypoparathyroidism cases in the literature. Traumatic metacarpal shortening differs from congenital agenesis [2]. This condition leads to both functional and cosmetic limitations which affect the patient's quality of life.
A 22-year-old male patient was admitted to our outpatient clinic with a traumatic left-hand fracture that caused a bone defect in the second metacarpal shaft leading to bone loss, shortening and flexion limitation in the second finger of the left hand, and a flexion contracture in the first metacarpophalangeal joint. For the treatment plan, an external fixator was set on the second metacarpal of the left hand for a 23 mm elongation over a period of 58 days, elongation rate was organized as 1 mm/day. After achieving the planned elongation, another operation was planned for the reconstruction of the bone defect that has occurred due to trauma in the second metacarpal bone. An osteotomy was performed for extracting an iliac crest graft and inserting it into the bone defect after debridement of scar tissue. For the first metacarpophalangeal joint, an arthrodesis was performed through the use of plate and screws. Multiple studies have showed a common complication of pin tract infections, which were controlled with oral antibiotics and local wound care [10, 11]. Proper alignment and union were achieved with early, stable fracture fixation of low-velocity gunshot wounds of the metacarpal. With early rehabilitation, treatment was provided without an increase in morbidity. [11].
It is possible to obtain acceptable surgical results when the method of fixation of the defect with autograft is used after lengthening with external fixator in pseudoarthrosis with metacarpal defect.
掌骨骨折常导致指骨明显缩短；其可由多种情况引起，从特发性、感染性到创伤性原因不等。文献中关于特发性原发性甲状旁腺功能减退症病例中掌骨缩短的报道非常罕见。创伤性掌骨缩短与先天性发育不全不同[2]。这种情况会导致功能和外观上的限制，影响患者的生活质量。
一名22岁男性患者因左手创伤性骨折入住我院门诊，该骨折导致第二掌骨干骨缺损，引起左手第二指骨骨质丢失、缩短和屈曲受限，以及第一掌指关节屈曲挛缩。对于治疗方案，在左手第二掌骨上设置外固定器，在58天内延长23毫米，延长速率设定为每天1毫米。达到计划延长后，计划进行另一项手术，以重建因第二掌骨创伤而出现的骨缺损。进行截骨术以获取髂嵴移植物，并在清除瘢痕组织后将其插入骨缺损处。对于第一掌指关节，通过使用钢板和螺钉进行关节融合术。多项研究表明针道感染是一种常见并发症，通过口服抗生素和局部伤口护理得以控制[10, 11]。通过早期、稳定地固定掌骨低速枪伤实现了正确的对线和愈合。通过早期康复，在不增加发病率的情况下提供了治疗。[11]
在掌骨缺损假关节的情况下，使用外固定器延长后采用自体移植修复缺损的固定方法，可以获得可接受的手术效果。
