Gonzalez M H, McKay W, Hall R F
Department of Orthopaedics, University of Illinois, Chicago.
J Hand Surg Am. 1993 Mar;18(2):267-70. doi: 10.1016/0363-5023(93)90359-B.
The results of early stable fixation of 64 metacarpal fractures due to low-velocity gunshot wounds in 49 patients were reviewed retrospectively. These reconstructive procedures were performed between 1 and 7 days after injury and involved stable internal fixation supplemented with primary iliac crest bone graft in 40 fractures with bone loss or comminution. Postoperatively, the hands were splinted with 90 degrees of metacorpophalangeal flexion while early interphalangeal motion was emphasized. Follow-up averaged 12 months, with a range of 4 months to 7 years. Primary bone union was achieved in all metacarpals. The average range of motion was 65 degrees for the metacarpophalangeal joint, 72 degrees for the proximal interphalangeal joint, and 60 degrees for the distal interphalangeal joint. Complications included two superficial infections. There were no cases of deep infections or persistent draining wounds. Early, stable fracture fixation of these injuries achieved union, alignment, and early rehabilitation with no appreciable increase in morbidity.
回顾性分析了49例患者64处因低速枪伤所致掌骨骨折早期稳定固定的结果。这些重建手术在受伤后1至7天内进行，其中40处存在骨质缺损或粉碎性骨折的病例采用了稳定的内固定并辅以取自髂嵴的一期骨移植。术后，手部用掌指关节屈曲90度的夹板固定，同时强调早期指间关节活动。随访平均12个月，范围为4个月至7年。所有掌骨均实现了一期骨愈合。掌指关节的平均活动范围为65度，近端指间关节为72度，远端指间关节为60度。并发症包括2例浅表感染。无深部感染或持续性引流伤口病例。对这些损伤进行早期、稳定的骨折固定可实现愈合、对线及早期康复，且发病率无明显增加。
