Bischoff R, Buechler U, De Roche R, Jupiter J
Department of Orthopaedics, Massachusetts General Hospital, Harvard University School of Medicine, Boston 02114.
J Hand Surg Am. 1994 Nov;19(6):1019-26. doi: 10.1016/0363-5023(94)90109-0.
We report 100 cases in which a tension-band technique was used to secure fixation of avulsion fractures within the digits. Included are 51 bony mallet fractures that were subluxed or irreducible, 38 displaced bony gamekeeper's fractures of the thumb, 8 fractures of the lateral phalangeal base, and 3 avulsion fractures that involved the base of the dorsal aspect of the middle phalanx. We evaluated results on the basis of clinical and x-ray film criteria. Excellent or satisfactory results were found in all 38 bony gamekeeper's injuries. All but one gamekeeper's fracture healed; the one nonunion was asymptomatic. All eight patients with lateral avulsion fractures had an excellent or satisfactory result on clinical examination. Seven of the eight had an excellent result on x-ray film evaluation; the one malnuion was asymptomatic. Two of the three fractures with dorsal avulsions of the base of the middle phalanx had a satisfactory result on clinical and x-ray film examination; the one poor result was due to the severity of the comminution of the fracture. However, 21 of the 51 bony mallet injuries had a poor result both clinically and radiographically. We noted numerous postoperative complications including dorsal skin breakdown, superficial and deep infection, and secondary displacement of the fragment. Tension-band fixation is an excellent method for treating various avulsion fractures of the hand such as bony gamekeeper's thumb, lateral avlusion injuries, and dorsal avulsions of the middle phalanx. However, the treatment of bony mallet fingers with tension band fixation is less predictable and should be used with caution.
我们报告了100例使用张力带技术固定手指撕脱骨折的病例。其中包括51例半脱位或无法复位的槌状指骨折、38例拇指移位性骨折、8例外侧指骨基底骨折以及3例累及中节指骨背侧基底的撕脱骨折。我们根据临床和X线片标准评估结果。在所有38例拇指骨折病例中均获得了优良或满意的结果。除1例骨折不愈合外，其余拇指骨折均愈合；该例不愈合者无症状。所有8例外侧撕脱骨折患者临床检查结果优良或满意。8例中有7例X线片评估结果优良；1例畸形愈合者无症状。3例中节指骨背侧撕脱骨折患者中有2例临床和X线片检查结果满意；1例效果不佳是由于骨折粉碎严重所致。然而，51例槌状指骨折中有21例临床和影像学结果均不佳。我们注意到许多术后并发症，包括背侧皮肤破溃、浅表和深部感染以及骨折块的二次移位。张力带固定是治疗手部各种撕脱骨折，如拇指骨折、外侧撕脱伤和中节指骨背侧撕脱骨折的一种优良方法。然而，使用张力带固定治疗槌状指骨折的效果较难预测，应谨慎使用。
