Through the evaluation of internal fixation with AO mini-plate for metacarpal and Phalanx (metatarsal phalanges) clinical curative effect of fracture. This set of 20 cases (23) the Metacarpus and phalanges (phalanges) application of internal fixation with AO mini-plate and complemented by early postoperative functional exercise. Results all months postoperative follow-up of patients with 2-12 fractures all healed, joint recovery. According to the Chinese Medical Association for surgery of the hand branch evaluation standard for hand function you 17 cases, benign and 2, may 1. Conclusions of application of internal fixation with AO mini-plate in treatment of metacarpal and phalangeal (metatarsal phalanges) has fixed firmly, reaches anatomic reduction and early activity function recovery of fracture well is a better method of fixation.
Hand and foot injuries of metacarpal and phalangeal (metatarsal phalanges) fracture incidence is high, previously not including plaster fixation with Kirschner wire internal fixation, due to fixed inaccurate, Kirschner and often through the articular surface, rival joint function recovery means greater impact. Special for openness, crushed and adjacent fracture of the articular surface, reset requires high, if not maintaining reliable fixed, prone to fracture and rotation angle, causing malunion, seriously affecting the functional recovery of fingers. In March 2005 to May ~2006 year on 20 cases in our hospital (23) of metacarpal and phalangeal (metatarsal phalanges) fracture treated by internal fixation with AO mini-plate and achieved satisfactory efficacy, are summarized as follows.
1 data and methods
1.1 General information on 20 cases of this group (23), men and 17 cases (20), girl 3 (3). Age 22~54sui, average age of 34. 7 cases of fracture of metacarpal bone, 6 cases of phalangeal fractures, metatarsal fracture in 5 cases (8), 2 phalanges fractures. Open fracture of 6 cases (7), 14 cases of closed fracture (16). Emergency operation for open fractures, closed fracture injuries 1-2 days after surgery.
1.2 brachial plexus anesthesia for surgical method of metacarpal and phalangeal fractures, metatarsal phalanges of lumbar anesthesia. Routine use of air tourniquet, strictly debridement of open fracture after fixation, dorsal side of closed fracture of the fracture parts take regular cut. Protection of extensor tendons, tendon tissue as possible during operation, exposed fracture breaking end, appropriate stripping periosteum, plastic fracture of steel plate at the back side. Selection direct micro-fracture of shaft of steel plate, metaphysis, or intra-articular fracture and selection of t-type micro-or l-plate.
1.3 functional exercise for postoperative analgesia after operation treatment for 3 days, intravenous infusion anti-inflammatory treatment for 3 days, compression bandage the wound. For stable after fracture with plate fixation does not need external fixation, for 3 days after beginning activities gradually, instability of comminuted or oblique fractures of plaster external fixation for the 3 weeks, gradually to joint functional exercises after the removal.
2 results
Postoperative follow-up of all cases of this group to 2-12 months, postoperative x-radiography fractures all healed, meet the anatomic reduction and knuckles range most normal activities, open fractures and soft tissue injury with better conditions of this group, no infection and necrosis of the skin occurs, all wounds are healed, 20 cases of which 12 have been admitted to hospital again in line removal of internal fixation steel plate. According to the Chinese Medical Association for surgery of the hand branch evaluation standard for hand function [1], 17 cases, benign and 2, may 1, excellent rate of 96%.
3 discussion
Hand and foot of metacarpal and phalangeal (metatarsal phalanges) or traditional treatments are plaster external fixation of fracture internal fixation with Kirschner, although the operation is simple, but due to long time fixing and joint damage to itself, joint contracture of lateral collateral ligament, and prone to joint stiffness, after lifting the external malformations and complications of traumatic arthritis. Application of internal fixation with AO mini-plate in treatment of hand and foot fractures, and would be fixed, stable, and facilitates joint exercises to ensure functional recovery, its advantages is the general consensus [2]. Our application of AO mini-plate in treatment of metacarpal and phalangeal (metatarsal phalanges) open, comminuted and intra-articular fractures of more shows its superiority. We selection AO straight micro plate fixed Palm phalangeal (Plantar phalanges) backbone fracture, its length not over joint surface; on Palm phalangeal (Plantar phalanges) head or basement Department fracture selection l type or t type micro-plate also not over joint surface, avoid has application grams’s needle runs through joint surface of shortcomings; on oblique line or comminuted fracture selection l type or t type micro-plate, can from different direction twist into screws, can will part broken bone tablets fixed, such part to solution has comminuted fracture of on bit problem [3].
Surgical indications and points for attention: application of AO mini-plate in treatment of metacarpal and phalangeal (metatarsal phalanges) fracture has its advantages, but its price is more expensive, and require two operations removed. For open fractures, if debridement does not complete, not strictly according to AO practice for operation can cause postoperative infections, skin necrosis, or nonUnion of plate exposure or [4]. Therefore AO mini-plate in treatment of metacarpal and phalangeal (metatarsal phalanges) fractures should have good indications: (1) has significantly displaced transverse, oblique, spiral fracture and comminuted fractures, (2) caused intra-articular fracture with transposition of articular surface flatness, and (3) of multiple fracture with transposition, and (4) good open fracture of certain skin conditions.
To full play AO micro plate treatment Palm phalangeal (Plantar phalanges) fracture of superiority, should note: (1) micro-invasive surgery technology, surgery reset Shi as possible less revealed bone organization protection fracture end blood for; (2) select suitable of plate, screws drilling fixed Shi guarantee once successfully, avoid screws loose; (3) plate placed in Palm phalangeal (Plantar phalanges) of back or side back, note will near reinforced film cover Yu plate Shang, to reduce tendon adhesion; (4) open fracture under specific situation select surgery programme, injury not over 8 h, wound pollution not serious, skin conditions relative better, in thoroughly Qing invasive of Foundation Shang can used AO micro plate within fixed; (5) operation Hou early function exercise using promote hand Department blood cycle recovery, swelling, and can prevention joint stiff, promote hand Department joint function of recovery.