Gonzalez M H, Hall M, Hall R F
Department of Orthopaedic Surgery, University of Illinois at Chicago, 60612, USA.
J Hand Surg Am. 1998 Jan;23(1):150-5. doi: 10.1016/S0363-5023(98)80103-2.
Twenty-eight proximal phalangeal fractures secondary to low-velocity gunshot wounds in 27 patients treated by stable fixation were retrospectively reviewed. Definitive fixation was performed within 1 week of injury. Fractures were stabilized with either a plate, intramedullary spacer, or a combination of both. When necessary, supplemental fixation was achieved with cerclage wires or interfragmentary screws. Twenty fractures with bone loss or comminution were primarily supplemented with iliac crest bone graft. After surgery, the fingers were splinted in 90 degrees of metacarpophalangeal (MP) flexion. An aggressive supervised therapy program was initiated within 24 hours of surgery. The average length of follow-up care was 9 months (range, 3-29 months). Primary union was achieved in all fractures. The average range of motion was 83 degrees for the MP joint and 66 degrees for the proximal interphalangeal joint. The average total active motion (TAM) for the involved digits was 200 degrees (range, 65 degrees-250 degrees). Fractures without intra-articular extension had a significantly better average TAM (213 degrees) than did those with intra-articular extension (169 degrees; p = .05). Primary bone grafting did not adversely effect the final TAM. There were no infections. Early stable fracture fixation of these injuries achieved union, alignment, and early rehabilitation with no appreciable increase in morbidity.
回顾性分析27例接受稳定固定治疗的因低速枪伤导致的28处近节指骨骨折。在受伤后1周内进行确定性固定。骨折采用钢板、髓内间隔器或两者联合进行固定。必要时，用环扎钢丝或骨折块间螺钉进行补充固定。20处有骨质缺损或粉碎性骨折的病例主要采用髂嵴植骨进行补充。术后，手指用掌指关节（MP）屈曲90度位进行夹板固定。术后24小时内开始积极的监督治疗方案。平均随访时间为9个月（范围3 - 29个月）。所有骨折均达到一期愈合。MP关节平均活动范围为83度，近端指间关节为66度。受累手指的平均总主动活动度（TAM）为200度（范围65度 - 250度）。无关节内延伸的骨折平均TAM（213度）明显优于有关节内延伸的骨折（169度；p = 0.05）。一期植骨对最终TAM无不利影响。无感染发生。对这些损伤早期进行稳定的骨折固定可实现骨折愈合、对线良好以及早期康复，且发病率无明显增加。
