Limited open reduction and internal fixation combined with mini external fixator to intra-articular fracture of the hand.

Abstract

Objective To investigate the method and clinical outcome of limited open reduction and internal fixation combined with mini external fixator to intra-artieular fracture of the hand. Methods From May 2002 to May 2007, twenty-six patients (21 males and 5 females) with intra-articular fracture of the hand were treated. Metaearpophalangeal joint was involved in 11 cases, proximal interphalangeal joint was in-volved in 13, and interphalangeal joint of thumb in 2. The patients aged from 12 to 52 years, averaged 25.5 years. Concomitant bone injury included metacarpal fracture in 3 eases, and seaphoid fracture in 1. Orthofix mini external fixator was used in all cases, and Kirschner wire, mini wire and absorbable suture were used for internal fixation. Concomitant fracture should be treated simultaneously with shape memory alloy,Kirsehner wire, or plate-screw system. Results The patients were followed up for 6-30 months,averaged 11.5 months. X-ray identified fracture union in all cases, and the average union time was 7 weeks ranging 5-12 weeks. Phalange shortening or rotation was noted in 2 eases, joint incongruity (less than 1 mm) and jointspace narrowing in 3 respectively. A proximal interphalangeal joint replacement was performed in one case with traumatic arthritis 1.5 years after surgery. 17 patients returned to their original living styles and occu-pations. ATM standard was used to evaluate the motion function of the injured fingers, which comprised of 8 excellent results, 13 good results, 3 fair results and 2 poor results. The overall good-excellent rate of joint motion function was 81%. No instability occurred in all joints at the follow-up. Conclusion Limited open reduction and internal fixation combined with mini external fixator is a reliable and effective method for in-tra-artieular fracture of the hand, and elinieal outcome is promising. Major problems, such as bone shorten-ing, rotation deformity and joint space narrowing, still exist. Key words: Fractures; Hand; External fixators; Fractures fixation, internal