Kaempf de Oliveira Ricardo, Fischer Paula, Trivino Victor, Marcovici Lucian Lior, Delgado Pedro J
Hand Surgeon, Santa Casa de Misericórdia de Porto Alegre Hospital, Brazil.
Orthopedics Resident, Santa Casa de Misericórdia de Porto Alegre Hospital, Brazil.
J Hand Microsurg. 2025 May 2;17(4):100276. doi: 10.1016/j.jham.2025.100276. eCollection 2025 Jul.
Only 4 % of metacarpal fractures affect the distal articular region. In the literature, some studies have ended up causing confusion by mixing up extraarticular neck fractures with subcapital fractures, a term that should only be used to define transverse articular fractures of the head that are distal to the origin of the collateral ligament. Due to the need for anatomical reduction, displaced metacarpal head fractures must be reduced and fixed, mostly by open surgery. Recently, the use of intramedullary fixation has become the method of choice in the treatment of transverse metacarpal diaphyseal and neck fractures. Having this in mind, we describe the so-called "lollipop" technique for the treatment of subcapital metacarpal fractures, in which a cortical mini-fragment screw is inserted through the head by intramedullary retrograde fixation in the diaphysis, leaving the final assembly in the shape of the candy. By using minimal fixation, the already impaired vascularity of the head articular fragments is protected, providing enough rigid stability for the fracture to heal in an anatomical position and allowing early mobility.
仅4%的掌骨骨折累及远侧关节区域。在文献中,一些研究将关节外颈部骨折与干骺端下骨折混为一谈,导致了混淆,而“干骺端下骨折”这个术语仅应用于定义侧副韧带起点远侧的头部横行关节内骨折。由于需要解剖复位,移位的掌骨头骨折必须进行复位和固定,大多通过切开手术进行。近来,髓内固定已成为治疗掌骨干和颈部横行骨折的首选方法。基于此,我们描述了治疗掌骨干部位骨折的所谓“棒棒糖”技术,即通过髓内逆行固定,将一枚皮质微型接骨螺钉经头部插入骨干,最终的固定装置呈糖果形状。通过采用最小化固定,可保护头部关节碎片本已受损的血供,为骨折在解剖位置愈合提供足够的刚性稳定性,并允许早期活动。