Application of pulleys forceps in the surgical treatment of basal fractures of the first metacarpal bone involving carpometacarpal joint

Abstract

Objective To investigate the application and clinical efficacy of pulley forceps in the surgical treatment of basal fractures of the first metacarpal bone involving carpometacarpal joint. Methods From June 2014 to December 2018, 14 cases of basal fractures of the first metacarpal bone involving carpometacarpal joint were treated. The space between abductor pollicis longus tendon and extensor pollicis brevis tendon was served as the first operative window. The fracture end and carpometacarpal joint of thumb were exposed. The periosteum was cut on the ulnar side of the extensor pollicis brevis tendon served as the second operative window. C-shaped pulley forceps was placed on the volar and ulnar side of the bone fragments. The bone fragments were hooked and controlled. The first metacarpal bone was pulled and pronated by an assistant. Under direct vision, anatomical reduction of bone fragments can be seen. Kirschner wire with a diameter of 1.0 or 1.2 mm was used to fix the fracture and carpometacarpal joint of thumb at the second and first operation windows respectively. After 4 weeks of plaster fixation, Kirschner wire was removed which was used for fixation of carpometacarpal joint of thumb and brace was used for fixation. The rehabilitation training of each joint of thumb was done intermittently. After 2 to 3 months, the remaining Kirschner wires were removed according to the fracture healing. Results After operation, all the wounds achieved primary healing. The articular surface was anatomically reduced and the fracture position was good. 10 patients were follow-up for 6 to 36 months. According to Gu Yudong evaluation method of opposition function, all the results were rated as excellent. The movement of carpometacarpal joint of thumb was normal in all directions. The VAS score was 0 in 7 cases, 1 in 1 case and 2 in 2 cases. Conclusion In the operation of the basal fractures of the first metacarpal bone involving carpometacarpal joint, C-shaped pulley forceps can reduce the operation difficulty, simplify the operation and improve the operation efficacy, which has a strong promotion significance. Key words: Fracture fixation; Treatment outcome; Pulley forceps; The base of the first metacarpal bone