Fractures Of Metacarpal Bones Research Articles

A new radiographic classification of fifth distal metacarpal fractures.

BackgroundThe fifth metacarpal fractures are the most common in all of hand fractures. To our knowledge, the classification of the fifth distal metacarpal bone fractures has not been studied.AimsThe aim of this study was to describe a new classification system based on x-ray and to evaluate its reliability and reproducibility.Material and methodsA total of 166 fifth distal metacarpal fractures were identified for classification and recorded. Two orthopedic surgeons reviewed and categorized them according to a newly designed classification. twice 1 month apart. Reliabilities of intra- and inter-observer were calculated with Spearman’s rho correlation coefficient.ResultsMean values of inter and intra-observer reliability were excellent (p = 0.85) and substantial (p = 0.70), respectively. In 166 patients (163 males and 3 females), concerning the percentage of the distribution of fracture types, the most common type was Type I accounted for 81 (48.8%) followed by Type II 70 (42.2%), Type III 11 (6.6%), and Type IV 4 (2.4%). Type Ia was the most prevalent among all groups.ConclusionThis study represented a unique classification system for fractures of the distal part of the fifth metacarpal bone. Categorization in radiographs might provide ideas regarding the prognosis and clinical outcomes of fracture patterns. Therefore, this study could guide future investigations to determine the first-line treatment of fifth distal metacarpal fracture patterns using this classification and help form a common language among surgeons concerning their treatment options.

TOOTH FRACTURES DUE TO MAXILLOFACIAL TRAUMA

Background Traumatic tooth fractures usually occur during a fight, fall, traffic accident, or sport activity. They often occur as a result of maxillofacial trauma. Because of their locations, the most commonly affected are the upper central and lateral teeth. Objective In this study, we aimed to describe risk factors of traumatic tooth fractures. Methods Patients referred to our forensic medicine center over 10 years were examined. Patients whose teeth were broken due to trauma were included in this study. Results There were 34 tooth fractures in 36,858 forensic cases examined due to trauma. Twenty-nine of the patients were male and 5 were female. The mean age was 36.9118 ± 13.09 years. Twenty-nine were due to assault and battery, and 5 were due to traffic accidents. It was observed that only the upper jaw was broken in 22, only the lower jaw in 4, and both the upper and lower jaw in 8 cases. Twenty-five patients had 1 or 2 tooth fractures and 29 patients had full fractures. Most of the fractures were accompanied by only soft tissue trauma. The most common bone fractures were metacarpal bone fractures. Conclusions Tooth fractures generally occur because of direct traumas, especially direct face traumas. Generally, fractures occurring in direct traumas are 1 or 2 tooth fractures due to local traumas.

The Measurement of the Inclination Angle of the Hamate and Analysis of the Inclination Angle for the Rotation Deformity of the Little Finger in the Fixation of the Carpometacarpal Joint.

ObjectiveComplex base fractures of the fifth metacarpal bone and dislocation of the fifth carpometacarpal joint are more prone to internal rotation deformity of the little finger sequence after fixation with a transarticular plate. In the past, we have neglected that there is actually a certain angle of external rotation in the hamate surface of transarticular fixation. This study measured the inclination angle of the hamate surface relative to the fifth metacarpal surface for clinical reference.MethodsIn a prospective single‐center study, we investigated the tilt angle of 60 normal hamates. The study included thin‐layer computed tomography (CT) data from 60 patients from the orthopaedic clinic and inpatient unit from January 2017 to March 2020, including 34 men and 26 women who were 15~59 years old, average 35 years old. The CT data of 60 cases in Dicom format of the hand was input into Mimics and 3‐Matics software for three‐dimensional (3D) reconstruction and measuring the angle α between hamate surface and the fifth metacarpal surface. According to the possible placement of the transarticular plate on the fifth metacarpal surface, we measured the angle β between the hamate surface 1 and the fifth metacarpal surface and the angle γ between the hamate surface 2 and the fifth metacarpal surface.ResultsThe average angle between the hamate surface and the fifth metacarpal surface was 11.66°. The hamate surfaces 1 and 2 have an external rotation angle of 7.30° and 7.51° on average with respect to the fifth metacarpal surface, respectively. There is no statistically significant difference in the angles between the two groups (P > 0.05).ConclusionsThe horizontal angle of the dorsal side of the hamate is different from the back of the fifth metacarpal surface, and the hamate has a certain external rotation angle with respect to the fifth metacarpal surface. No matter how the transarticular plate is placed, the plate always has a certain external rotation angle relative to the fifth metacarpal surface. When the fixation is across the fifth carpometacarpal joint, if the plate does not twist and shape, it will inevitably cause internal rotation of the fifth metacarpal, resulting in internal rotation deformity of the little finger sequence.

Antegrade intramedullary nailing in comminuted, open metacarpal bone fracture: maintenance of the length.

The purpose of this study was to evaluate the radiological and clinical outcomes of treatment of comminuted open fractures of the metacarpal bone (MCB) with associated injuries to soft tissues, tendons, and neurovascular structures using antegrade intramedullary nailing (AIN) at least 2years postoperatively. Between January 2008 and December 2017, a total of 27 patients who met the inclusion/exclusion criteria were included in this study. The inclusion criterion was open and comminuted fracture (with/without segmental bone defects). We evaluated simple radiograph and computed tomography (CT) findings and clinical conditions (visual analog scale [VAS] pain score and Disabilities of the Arm, Shoulder, and Hand [DASH] score), including active range of motion (ROM) at metacarpophalangeal joint (MP) and grip strength at final follow-up. The mean preoperative angulation was 29.63° ± 7.59° and the mean shortening was 9.30 ± 2.38mm. Union was achieved at mean 12.3weeks postoperatively, without any complications due to operative treatment. The dorsal angulation measured on the CT scans, shortening on simple radiographs was significantly improved (10.26 °± 3.19°, 0.52 ± 1.05mm, respectively). The final VAS and DASH scores were 0.41 ± 0.64 and 3.6 ± 2.47, respectively, indicating satisfactory outcomes. The final ROM was 85.0° ± 3.67°. The mean final grip strength was 89.56 ± 5.69% relative to the normal side. A mean extension lag at the MP joint of 12° was noted in three patients; however, it was resolved by additional tenolysis. AIN is a simple method for fixation of open comminuted metacarpal fractures accompanied by soft tissue injury. The simplicity of the method is beneficial for repairing associated injured structures and healing soft tissue. Minimized additional damage around the MCB during surgery and good stability resulted in satisfactory bony union with minimal angulation, shortening, and rotation. Level IV, Retrospective case series.

A Safe Method for Early Rehabilitation of Articular Fracture at the Base of Thumb Metacarpal Bone.

Background To evaluate the clinical and radiological results of closed reduction, distraction using an external fixator, and percutaneous fixation in patients with Bennet and Rolando fractures. Methods Patients over 18 years of age, who had isolated fracture at the base of the first metacarpal bone, had no previous functional limitations and pain complaints, were regularly followed up, and had fixation using K-wire combined with an external fixator, were included. Arthrosis was evaluated according to Eaton and Littler classification. Pain intensity was evaluated using the visual analogue scale (VAS) on a 0–10 scale. Furthermore, patients were questioned regarding limitations in their daily activities and hobbies. Pinch and grasp strengths were evaluated. Results Thirteen of the patients were male and five were female, with a mean age of 31.5 ± 12.5 years. The surgical procedure was performed on the right extremity in 12 patients and left extremity in six patients. Twelve patients were found to have Bennet fractures, whereas six patients had Rolando fractures. The mean follow-up period of the patients was found to be 29.6 ± 5.4 months. The VAS score was rated as 2 in one patient and 1 in one patient. Other patients had a pain VAS score of 0. The mean Quick-DASH score was calculated to be 1.20. No statistical difference was found in pinch strength between the two extremities (p > 0.05). No difference was observed in terms of the range of motion (p > 0.05). Conclusion Fixation using K-wire combined with an external fixator has more benefits than its disadvantages and is superior to other methods in the intra-articular fractures of the first metacarpal bone.

Hand injuries in children and adolescents

Introduction/Objective. The objective of the study was to determinate which groups in the population of children are most prone to hand injuries and to identify the causes of the injuries with the aim of further developing better means of severe injuries prevention that can lead to invalidity. Methods. A retrospective epidemiological study was carried out, and included all children with hand injuries admitted to our hospital between January 1, 2010 and December 31, 2017; The data were collected and analyzed statistically using SPSSR. Significance was defined as p < 0.05. Results. The total number of patients was 254, 202 boys and 52 girls, with a mean age for both sexes 10.13 years (range1?17). The majority of patients were from an urban population 56.7% and 43.3% were from a rural area. Regarding the month in the year when the injury occurred, there were two peaks, in January and in May. The right hand was more affected, 53.2%, than the left, 45.6%, and both hands were affected in 1.8% of cases. Isolated soft tissue injuries (skin, muscles, tendons) were present in 59% of cases, isolated bone injuries (phalangeal and metacarpal bone fractures) in 15.3%, and both soft tissue and bone injuries in 25.7% of cases. The little finger was the most affected, followed by the long finger and thumb, index and ring finger, respectively. The most serious injuries were from explosive wounds caused by firecrackers and handling agricultural tools and engines. Conclusion. Hand injuries in childhood are common and can have devastating consequences. Developing prevention program by raising awareness about this issue is of vital importance.

La «méthode trigonométrique» pour une mesure simple de l’angulation palmaire dans les fractures du cinquième métatarsien

IntroductionSubcapital fractures of the 5th metacarpal bone (MCV) represent a common injury. Volar angulation measurement is essential for treatment decision-making and therefore needs a reliable and valid method. The purpose of the present study was to investigate a new technique for volar angulation measurement, called the ‘Trigonometric Technique’ (TT), and to compare the TT with the reference standard based on computed tomography (CT). HypothesisQuantifying volar angulation in MCV neck fractures with the TT shows no difference compared to the angle measured on CT scans. Material and MethodsFifteen patients (14 men and 1 woman) with a mean age of 37±16 years (range, from 16 to 72 years) who suffered MCV neck fracture and met the inclusion and exclusion criteria were selected for this prospective cohort study. Radiologic investigation included simple dorsopalmar (DP) radiographs and CT scans from the injured hand. Volar angulation measurements were performed by three observers at two time points comparing the TT to measurements obtained on CT scans. Intraclass correlation coefficients (ICC) were determined to assess inter- and intra-observer reliability. ResultsThe TT showed a mean volar angulation of 39±5 degrees (range, from 26 to 46 degrees) compared to 41±7 degrees (range, from 28 to 54 degrees) on CT measurement, which revealed a significant correlation between the two measurement techniques (R=0.922, p<0.001). Overall, the inter-rater (R=0.977; 95 % CI: 0.945–0.992) as well as intra-rater (R=0.857; 95 % CI: 0.739–0.941) reliability for the volar angulation using the TT was excellent. ConclusionThe TT presented in this study uses plain radiography and trigonometric identities to precisely determine volar angulation in MCV neck fractures. The TT correlates excellently with the obtained volar angulation angles measured on CT scans. We recommend the TT for volar angulation measurement in boxer's fracture as a reliable alternative to the conventional techniques. However, rotational abnormalities may remain undetected and should therefore be ruled out during clinical examination. Level of Evidence IIStudy of diagnostic test.

The “Trigonometric Technique” for simple measurement of volar angulation in boxers’ fractures

IntroductionSubcapital fractures of the 5th metacarpal bone (MCV) represent a common injury. Volar angulation measurement is essential for treatment decision-making and therefore needs a reliable and valid method. The purpose of the present study was to investigate a new technique for volar angulation measurement, called the “Trigonometric Technique” (TT), and to compare the TT with the reference standard based on computed tomography (CT). HypothesisQuantifying volar angulation in MCV neck fractures with the TT shows no difference compared to the angle measured on CT scans. Material and methodsFifteen patients (14 men and 1 woman) with a mean age of 37±16years (range, from 16 to 72 years) who suffered MCV neck fracture and met the inclusion and exclusion criteria were selected for this prospective cohort study. Radiologic investigation included simple dorsopalmar (DP) radiographs and CT scans from the injured hand. Volar angulation measurements were performed by three observers at two time points comparing the TT to measurements obtained on CT scans. Intraclass correlation coefficients (ICC) were determined to assess inter- and intra-observer reliability. ResultsThe TT showed a mean volar angulation of 39±5 degrees (range, from 26 to 46 degrees) compared to 41±7 degrees (range, from 28 to 54 degrees) on CT measurement, which revealed a significant correlation between the two measurement techniques (R=0.922, p<0.001). Overall, the inter-rater (R=0.977; 95% CI 0.945–0.992) as well as intra-rater (R=0.857; 95% CI 0.739–0.941) reliability for the volar angulation using the TT was excellent. ConclusionThe TT presented in this study uses plain radiography and trigonometric identities to precisely determine volar angulation in MCV neck fractures. The TT correlates excellently with the obtained volar angulation angles measured on CT scans. We recommend the TT for volar angulation measurement in boxer's fracture as a reliable alternative to the conventional techniques. However, rotational abnormalities may remain undetected and should therefore be ruled out during clinical examination. Level of evidenceII, study of diagnostic test.

Second Place Award: Long-term patient-reported outcomes after intramedullary Kirschner-wire fixation for displaced subcapital fractures of the fifth metacarpal bone: A retrospective cohort study

Background: The objective of this study was to analyze complications and patient-reported functional outcome after antegrade intramedullary Kirschner-wire fixation of displaced subcapital fractures of the fifth metacarpal bone. Methods: All consecutive patients treated from January 2010 to December 2015 were retrospectively identified using patient logs and radiographic images. Indications for operative fixation were angulation greater than 40 degrees, shortening less than 2 mm, or rotational deficit. Complications were registered from the patient logs. Functional outcome was assessed with the Patient-Rated Wrist/Hand Evaluation (PRWHE) and Disabilities of the Arm, Shoulder and Hand Score (DASH) questionnaires, both ranging from 1-100. Results: Fifty-one patients could be included, with two patients lost to follow-up. The mean outpatient follow-up was 9 wk, and the interval for functional assessment was 34 mo with 40 patients (78%) having responded to the questionnaires. Forty-seven patients (92%) proceeded to fracture union, while the recovery of two patients was complicated by migration of the Kirschner wires through the distal cortex into the metacarpophalangeal joint respectively 5 and 6 wk after primary surgery. Eight minor complications were registered, including a superficial skin infection, mild local dysesthesia or a 10- to 20-degree extension lag at the end of outpatient follow-up. Overall, in 41 patients (80%) the Kirschner wires were removed. Long-term functional outcome was excellent with mean PRWHE and DASH scores of, respectively, 3 and 6 points. Conclusions: If surgical treatment is considered, we recommend temporary antegrade intramedullary Kirschner wire fixation as a reliable therapeutic method with a low complication rate and excellent long-term functional outcome. Level of Evidence: Level III.

HAND INJURY

HISTORY: A 15 year old H.S. football quarterback sustained a right thumb injury while throwing a pass. His hand hit a defender’s chest during follow through, jamming his thumb. He noted swelling and bruising over thenar eminence and his 2nd MCP joint. This resulted in limited ROM of the right thumb especially of abduction and opposition. PHYSICAL EXAMINATION: Examination of the right hand showed edema along the 1st MCP joint, thenar eminence with ecchymosis in 1st webspace extending into 2nd MCP joint. Skin was intact. Thumb was well vascularized. No tenderness over 2nd metacarpal or 2nd MCP joint. Thumb opposition and 1st MCP flexion and extension less than 20° were limited by edema and pain, IP ROM was within functional limits. Tenderness over ulnar aspect of 1st MCP joint . Pain and tenderness present during MCP extension with mild laxity with UCL stressing. Laxity at the CMC joint with some dorsal subluxation, reducible. Tenderness proximal to trapezium. Contralateral side thumb revealed also some laxity at the CMC. DIFFERENTIAL DIAGNOSIS: 1. Fracture of the right 1st Metacarpal bone 2. Fracture of the right thumb proximal phalanx 3. Fracture of the wrist bones 4. Right 1st MCP joint UCL sprain TEST AND RESULTS: X-rays of the right hand 3V: No bony or soft tissue abnormalities. MRI right hand ordered to rule out occult fracture(s), ligament tears : 1. Nondisplaced fracture of the trapezium. Diffuse bone marrow contusion in the 1st metacarpal with small avulsion fragment of the radial metacarpal at RCL attachment 2. Bone contusion of the distal dorsal capitate 3. Moderate grade sprain of UCL and RCL at the thumb MCP joint with partial tearing of proximal RCL at the avulsion fragment. 4. Diffuse low grade muscle strain with superimposed partial musculotendinous tear of flexor pollicis brevis muscle. TREATMENT AND OUTCOMES: 1. Wrist and thumb immobilization in Custom thumb spica splint to enable graduated ROM as tolerated and Occupational Therapy 2. Restriction from all contact sports for 6 weeks 3. Consultation with Hand Orthopedist to evaluate for surgical necessity determined patient to be appropriate for conservative treatment. Patient seen in Sports Medicine Clinic 39 days after initial injury. Returned to sports after 6 weeks of immobilization with thumb/wrist taped . Patient denied pain with activity.

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

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

Functional evaluation of various surgical modalities in treatment of hand fractures

Background: “Hand fractures can be complicated by deformity from no treatment, stiffness from over treatment, both deformity and stiffness from poor treatment.” - Swanson. Fracture of metacarpal bone of the hand constituting between 14-28% of all visit to hospital following trauma by various means like assault, road traffic accidents, industrial accidents, agriculture accidents etc. Fracture of the bones of hand are among the commonest fracture in humans, but their management varies widely in the different regions of world. This variability is due to many reasons, including availability of resources, social factors, geographic constraints, surgeon preference and experience, and local practice patterns. Among the spectrum of hand and wrist injuries, fractures of the wrist rank first in terms of frequency and morbidity, with an estimated incidence of 400 fractures per 100,000 inhabitants per year3. 3 Fracture healing in the hand is not an isolated goal; rather the functional result is of paramount importance. Recent studies have shown good functional results with surgical treatment of metacarpal fractures using K-wires, bicondylar plates and screws as compared to conservative treatment. Material and Method: The sample size of the study was 28 patient in 12 patient in k-wire group, 8 patient in jess group and 8 in plate group. The functional outcome was assessed by calculating Total active range of motion (TAM) as suggested by the American Society of Surgery of Hand. At every follow up TAM (total active range of motion) will be calculate as follows TAM= (Active flexion at MCP+PIP+DIP)-Extension deficit at MCP, PIP, DIP. Recovery was calculated as percent regained in motion compared to normal range of digital motion (260 degree). Result: Fracture healing in the hand is not an isolated goal; rather the functional result is paramount importance. JESS, Plating and K-wire comprised of 8, 8 and 12 subjects respectively. Mean age (in years) of the subjects in JESS group was 41.75±21.93 while the mean age of the subjects in plating and K-wire group was 39.12±20.18 and 43.83±21.84 respectively. 14.35, 21.4% and 17.9% of the subjects in JESS, Plating and K-wire group respectively were injured due to fall from height. Road traffic as mode of injury was reported in 14.3%, 7.1% and 25% of the subjects in JESS, Plating and K-wire group respectively. Conclusion: Plate and screw fixation is a good option for treating closed unstable metacarpal fractures, where other modalities of fixation are less effective, the rigid stable fixation provided by plating which withstands load without failure allowed early mobilization and achieved good functional results.

Metacarpal fractures in children (literature review)

Hand injury holds one of the first places among injuries of the musculoskeletal system in children. The share of fractures of metacarpal bones account for 10 to 35 % of all fractures, while for 1/5 of pediatric patients they are accompanied by injury to the growth plate. The existing classification of pediatric metacarpal fractures does not accurately reflect the nature and extent of damage to the growth plate; it underestimates or overestimates the nature of the fracture, the degree of displacement of fragments of metacarpal bones with the traditional approach to treatment, without taking into account the age-related anatomical and physiological characteristics of the traumatized child. Further scientific research on the diagnosis and treatment of traumatic injuries of metacarpal bones in children, the introduction of the results of these studies into clinical practice will contribute to improving the quality of care for patients with hand injuries and to preventing disability of the children.

Fractures of metacarpal bone: evaluation of functional outcome of open reduction and internal fixation with mini locking plate: a hospital based study

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Metacarpal bones fracture is very common. Management of metacarpal fractures varies from conservative to percutaneous pinning to various surgical methods. We endeavour to evaluate the functional outcome of metacarpal fractures in patients managed with open reduction and internal fixation with mini locking plate.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; A total of 32 patients with extra-articular metacarpal bones fracture were recruited for the study. After open reduction the fractures were fixed with the mini locking plate, postoperative day 3, plaster removed and active and passive exercises started. The Michigan hand score was used for functional evaluation, grip strength, visual analogue scale score, range of motion evaluated at follow up till six months.&lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; All the 32 patients achieved union, 31 had full union at 6 weeks whereas 1 patient has delayed union. The Michigan hand outcome questionnaire score of 97.5 % at 6 months in all 32 patients. A total of 5 out of 32 patients had complications, the most common being finger stiffness followed by superficial infection and delayed union.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; We concluded that metacarpal plating with mini locking plate is a good option to achieve and maintain a rigid fixation and this method produces a better outcome in unstable fractures of metacarpal bones.&lt;/p&gt;

Application of dorsal supporting plate for treatment of the fourth and fifth carpometacarpal joint fractures and dislocations

Objective To report the clinical efficacy of dorsal lateral supporting plate in the treatment of the fourth and fifth carpometacarpal joint fractures and dislocations. Methods From June 2010 to May 2017, 7 patients with the fourth and fifth carpometacarpal joint fractures and dislocations were treated by dorsal lateral supporting plate and Kirschner wire fixation. The fractures of the hamate bone were all Cain type Ⅱunstable fractures, including 1 case of type ⅡA, 4 cases of type Ⅱ B, and 2 cases of type Ⅱ C. Among them, 2 cases had the base of the fourth and fifth metacarpal bone fractures, and 2 cases had only the base of the fourth metacarpal bone fracture. Results All the wounds achieved primary healing. The fracture healing time ranged from 8 to 12 weeks. The internal fixation was taken out depending on the healing of the fracture. All the patients were follow-up from 5 to 12 months with an average of 7 months. The flexion and extension function of all the hand joints recovered well. According to the upper extremity function evaluation criteria issued by the Hand Surgery Society of the Chinese Medical Association, the results were rated as excellent in 4 cases and good in 3 cases. Conclusion The treatment of fractures and dislocations of the fourth and fifth carpometacarpal joints with dorsal supporting plate and Kirschner wire fixation can provide stable fixation in multiple planes and directions, which is helpful for early functional exercise. Key words: Hamate bone; Carpometacarpal joints; Fractures,bone; Dislocations

Standing repair of an articular dorsal medial oblique fracture of the proximal third metacarpal bone in a racing Standardbred

SummaryThe third metacarpal bone (McIII) is a common site of long bone fractures in racehorses. However, articular fractures of the dorsomedial aspect of McIII are a rare location of such injuries. This report describes the successful standing surgical repair of an articular fracture of the dorso‐medial proximal McIII in a 4‐year‐old Standardbred racing mare using lag screw fixation.

Mini-Open Reduction of Isolated Metacarpal Bone Fracture

Mini-Open Reduction of Isolated Metacarpal Bone Fracture

Comparison of Hematoma Block and Wrist Block in the Treatment of Fracture of Neck of Fifth Metacarpus

Background: Fracture of neck of fifth metacarpal bone or boxer fracture is one of the most common types of hand fracture. Nowadays, two analgesic methods, hematoma block and wrist block, are used at the emergency unit for relocating the fracture. The aim of this study was to compare the advantages and disadvantages of these two methods.Methods: In this randomized clinical trial, all male patients between age of 18 and 60 years were evaluated regarding the inclusion criteria and divided into two groups. In the first group (wrist block), after finding the landmarks and using nerve locator, the radial, median, and ulnar nerves were blocked using 2% lidocaine. In the second group (hematoma block), 2% lidocaine was injected at the site of fracture hematoma. Patients’ pain in both groups was assessed using the visual analogue scale (VAS) before, during, and five minutes after reduction. Correction of angle of fracture and hand grip power were evaluated at two months, post-treatment.Results: Forty-eight patients in the wrist block and 50 patients in the hematoma block were enrolled. In both groups, pain level based on VAS score was decreased during and at five minutes after reduction, which was significant in the wrist block group at both times. No significant associations were detected between correction of angle of fracture and recovery of hand grip power at two months post-treatment with type of analgesia. Also, grip power showed a significant negative association with age, only in the wrist block group.Conclusions: This study demonstrated that wrist block is more effective than hematoma block during and at five minutes after reduction. However, two months after treatment, it was found that grip power was inversely proportional to the age in the wrist block group.

Effectiveness analysis of maintaining the stability between the fourth and the fifth metacarple base during the treatment in the hamate-metacarpal joint injury

To explore the effectiveness of maintaining the stability between the fourth and the fifth metacarple base during the treatment in the hamate-metacarpal joint injury. Between September 2015 and June 2017, 13 cases of hamate-metacarpal joint injury were treated, including 12 males and 1 female, aged from 17 to 55 years (mean, 30.8 years). The injury causes included heavy boxing in 10 cases and falling in 3 cases. There were 2 cases of simple fourth metacarpal basal fracture, 1 basal fracture of the fourth metacarpal bone combined with intermetacarpal ligament fracture, 7 fractures of the fourth and fifth metacarpal base, 2 fourth metacarpal basal fractures combined with the fifth metacarpal basal fracture dislocation, and 1 base fracture of fourth and fifth metacarpal bone combined with hamate bone fracture. The time from injury to operation was 5-11 days (mean, 7.2 days). According to different damage degree and stability change between the fourth and the fifth metacarple base, a preliminary classification was made for different degrees of injury: 2 cases of type Ⅰ, 1 case of type Ⅱ, 7 cases of type Ⅲ, 2 cases of type Ⅳ, and 1 case of type Ⅴ. The patients were treated with corresponding internal fixation methods under the principle of stability recovery between the fourth and fifth metacarple base. All the incisions healed by first intention without infection or skin necrosis. All the 13 patients were followed up 6-18 months with an average of 9.4 months. All fractures healed clinically, and the healing time was 5.5-8.0 weeks with an average of 6.3 weeks. No complication such as plate breakage, fracture dislocation, fracture malunion, and bone nonunion occurred. Hand function was evaluated according to the total active motion (TAM) functional evaluation standard of hand surgery at 6 months after operation, and the results was excellent in 9 cases, good in 3 cases, and fair in 1 case, with an excellent and good rate of 92.3%. Stability between the fourth and fifth metacarple base is of great significance to the classification and the treatment of the hamate-metacarpal joint injury.

Management of Metacarpal and Phalangeal Bone Fractures of the Hand

Background: Hand fractures are one of the most commonfractures presenting at accident and emergency units. Becauseof the complexity of the hand; management of hand fracturescan be very challenging. Fixation of hand fractures can bedone by multiple methods including percutaneous K-wiresfixation and open reduction and internal fixation with eitherinterosseous wiring or mini plate and screws. This comparativeclinical study is to review the indications and long term resultsof each method.Methods: Thirty patients with hand fractures were includedin our study, ten of them treated with percutaneous K wirefixation (group A), another ten patients were treated withopen reduction and internal fixation with interosseous wiring(group B)and the last ten patients were treated with openreduction and internal fixation with miniplate and screws(group C). The duration of this study was for eleven monthswith patient's age ranging from 15-50 years old. The type ofsurgical intervention used was determined according to thefracture pattern.Results: All patients treated in this study had clinical andradiological union by the 10th week. Patients treated withpercutaneous K wire fixation had better range of movementand earlier return to work with less complications than patientstreated with open reduction and internal fixation with interosseouswiring or mini-plate and screws.Conclusion: Percutaneous fixation of unstable metacarpaland phalangeal fractures is a reliable and safe method for themajority of fracture patterns with higher ROM and lesscomplications in comparison with the other two methods.