Gropper P T, Bowen V
Clin Orthop Relat Res. 1984 Sep(188):203-7.
Preventing the deformities of rotation and shortening is essential in the treatment of metacarpal fractures. Maintenance of accurate reduction is often difficult to achieve by cast immobilization or by the more sophisticated techniques that use plates and screws. During a four-year period, 92 of 290 metacarpal fractures were treated by open reduction and internal fixation. Of these, 21 were oblique and spiral fractures that were treated by cerclage wiring. The operation is performed with two to three lengths of No. 24 prestretched stainless steel wire that is tightened around the metacarpal shaft following fracture reduction. Mobilization of the hand is begun ten days following surgery, and full, unlimited use is permitted after six weeks. All 21 metacarpal fractures were followed up until the patient was ready to return to work, which occurred an average of seven weeks after surgery. Seventeen patients had no restriction of range of motion, with normal anatomic restoration of the metacarpal. Three patients lost 15 degrees of total active finger motion, and one had an extension lag of 10 degrees at the metacarpophalangeal joint.
预防旋转和短缩畸形在掌骨骨折的治疗中至关重要。通过石膏固定或使用钢板和螺钉等更复杂的技术往往难以维持精确复位。在四年期间，290例掌骨骨折中有92例接受了切开复位内固定治疗。其中，21例斜形和螺旋形骨折采用环扎钢丝治疗。手术使用两到三段预拉伸的24号不锈钢丝，在骨折复位后围绕掌骨干拧紧。术后十天开始手部活动，六周后允许完全不受限制地使用。所有21例掌骨骨折均随访至患者准备恢复工作，平均在术后七周。17例患者关节活动范围无受限，掌骨解剖结构恢复正常。3例患者总主动手指活动度丧失15度，1例掌指关节伸展滞后10度。
