目的介绍应用跨关节桥接钢板内固定技术治疗钩骨-掌骨关节骨折背侧脱位的手术技术及疗效。方法 2008年8月至2015年12月,应用跨关节桥接钢板内固定技术治疗55例钩骨-掌骨关节骨折背侧脱位患者。采用Cain分型,其中ⅠA型8例,ⅠB型27例,Ⅱ...目的介绍应用跨关节桥接钢板内固定技术治疗钩骨-掌骨关节骨折背侧脱位的手术技术及疗效。方法 2008年8月至2015年12月,应用跨关节桥接钢板内固定技术治疗55例钩骨-掌骨关节骨折背侧脱位患者。采用Cain分型,其中ⅠA型8例,ⅠB型27例,Ⅱ型13例,Ⅲ型7例。应用2.3 mm Stryker微型直钢板,切开复位钩骨-掌骨关节骨折背侧脱位并跨钩骨和4,5腕掌关节固定,手术后行早期功能锻炼。术后4个月去除钢板。结果术后所有患者获随访6~48个月,平均2.5年。55例骨折均顺利愈合,愈合时间平均5.5周。术后疼痛程度和关节活动度评价,优39例,良14例,可2例,差0例,优良率为96.3%。术后未发生严重并发症和脱位复发。结论应用跨关节桥接钢板内固定技术治疗钩骨-掌骨关节骨折背侧脱位,复位固定可靠,允许早期关节活动,无术后脱位复发和关节不稳定的风险,有效降低术后关节疼痛和关节活动受限,是治疗钩骨-掌骨关节骨折背侧脱位的有效方法。展开更多
BACKGROUND Basal joint arthritis is a common disease which is especially present in postmenopausal women. A variety of procedures have been described once conservative treatment has failed. The purpose of our study is...BACKGROUND Basal joint arthritis is a common disease which is especially present in postmenopausal women. A variety of procedures have been described once conservative treatment has failed. The purpose of our study is to present a novel surgical technique based on a clinical case with three-year follow-up which is highly effective, even after failure of previous procedures. CASE SUMMARY We present a case of a 39 year-old-woman who suffered from recurring, persistent, sharp left thumb pain for several years After two operative procedures, she presented again with intolerable, sharp pain over the trapeziometacarpal joint, and wished to proceed with a pain relieving procedure or arthroplasty. Intraoperatively, the articular surfaces appeared well, without any bare areas of bone or eburnation, resulting in the decision to perform a “subtraction hemiarthroplasty”. A shortening osteotomy of the os trapezium was performed by removing a slice of 8-9 mm bone, without damaging the joint cartilages. The osteotomy was stabilized using two screws, the ligament and capsular tissue was suture imbricated, and a cut down on the translation and a dorsal radial ligament reconstruction were performed. Three years after the final procedure, a long-term follow-up demonstrates excellent results, pain free with full range-of-motion. CONCLUSION Subtraction hemiarthroplasty with ligament tightening imbrication and reconstruction of the radial ligament led to excellent results in motion and pain.展开更多
BACKGROUND We report a case with the displacement of an articular fracture fragment of the base of the second metacarpal from the ulnar to the volar side,treated via the dorsal approach.The dorsal approach can be a go...BACKGROUND We report a case with the displacement of an articular fracture fragment of the base of the second metacarpal from the ulnar to the volar side,treated via the dorsal approach.The dorsal approach can be a good option not only because it allows direct observation of ligament damage and fixation of bone fragments but also because the thin subcutaneous tissue makes the approach easier.CASE SUMMARY A 45-year-old man with a right hand injury visited the hospital.A small bone fragment was identified using plain radiography.Lateral radiography revealed the fragment as lying over the volar aspect of the carpometacarpal(CMC)joint.Computed tomography revealed that approximately one-third of the CMC joint surface of the second metacarpal was damaged.We provisionally diagnosed an intra-articular fracture with significant CMC joint instability and performed open reduction and internal fixation.We made a dorsal longitudinal incision over the CMC joint between the second and third metacarpals.The dorsal ligament of the third CMC joint was torn.We thought it had been dislocated to the volar side and spontaneously reduced to that position.There are only few reports of volar dislocation of CMC joint fractures,particularly of the second and third metacarpals;our report is unique as our patient had an intact interosseous ligament between the second and third metacarpals.CONCLUSION Although past reports have used a palmar approach,the dorsal approach is a good option for these cases.展开更多
Double fracture-dislocations of the thumb are rare. Only a single case report of a simultaneous extraarticular fracture of the base of the first metacarpal and dislocation of the metacarpophalangeal joint has been pre...Double fracture-dislocations of the thumb are rare. Only a single case report of a simultaneous extraarticular fracture of the base of the first metacarpal and dislocation of the metacarpophalangeal joint has been previously reported. We report the second case report of this injury in a 20-year-old man. The patient had an excellent outcome after treatment.展开更多
文摘目的介绍应用跨关节桥接钢板内固定技术治疗钩骨-掌骨关节骨折背侧脱位的手术技术及疗效。方法 2008年8月至2015年12月,应用跨关节桥接钢板内固定技术治疗55例钩骨-掌骨关节骨折背侧脱位患者。采用Cain分型,其中ⅠA型8例,ⅠB型27例,Ⅱ型13例,Ⅲ型7例。应用2.3 mm Stryker微型直钢板,切开复位钩骨-掌骨关节骨折背侧脱位并跨钩骨和4,5腕掌关节固定,手术后行早期功能锻炼。术后4个月去除钢板。结果术后所有患者获随访6~48个月,平均2.5年。55例骨折均顺利愈合,愈合时间平均5.5周。术后疼痛程度和关节活动度评价,优39例,良14例,可2例,差0例,优良率为96.3%。术后未发生严重并发症和脱位复发。结论应用跨关节桥接钢板内固定技术治疗钩骨-掌骨关节骨折背侧脱位,复位固定可靠,允许早期关节活动,无术后脱位复发和关节不稳定的风险,有效降低术后关节疼痛和关节活动受限,是治疗钩骨-掌骨关节骨折背侧脱位的有效方法。
文摘BACKGROUND Basal joint arthritis is a common disease which is especially present in postmenopausal women. A variety of procedures have been described once conservative treatment has failed. The purpose of our study is to present a novel surgical technique based on a clinical case with three-year follow-up which is highly effective, even after failure of previous procedures. CASE SUMMARY We present a case of a 39 year-old-woman who suffered from recurring, persistent, sharp left thumb pain for several years After two operative procedures, she presented again with intolerable, sharp pain over the trapeziometacarpal joint, and wished to proceed with a pain relieving procedure or arthroplasty. Intraoperatively, the articular surfaces appeared well, without any bare areas of bone or eburnation, resulting in the decision to perform a “subtraction hemiarthroplasty”. A shortening osteotomy of the os trapezium was performed by removing a slice of 8-9 mm bone, without damaging the joint cartilages. The osteotomy was stabilized using two screws, the ligament and capsular tissue was suture imbricated, and a cut down on the translation and a dorsal radial ligament reconstruction were performed. Three years after the final procedure, a long-term follow-up demonstrates excellent results, pain free with full range-of-motion. CONCLUSION Subtraction hemiarthroplasty with ligament tightening imbrication and reconstruction of the radial ligament led to excellent results in motion and pain.
文摘BACKGROUND We report a case with the displacement of an articular fracture fragment of the base of the second metacarpal from the ulnar to the volar side,treated via the dorsal approach.The dorsal approach can be a good option not only because it allows direct observation of ligament damage and fixation of bone fragments but also because the thin subcutaneous tissue makes the approach easier.CASE SUMMARY A 45-year-old man with a right hand injury visited the hospital.A small bone fragment was identified using plain radiography.Lateral radiography revealed the fragment as lying over the volar aspect of the carpometacarpal(CMC)joint.Computed tomography revealed that approximately one-third of the CMC joint surface of the second metacarpal was damaged.We provisionally diagnosed an intra-articular fracture with significant CMC joint instability and performed open reduction and internal fixation.We made a dorsal longitudinal incision over the CMC joint between the second and third metacarpals.The dorsal ligament of the third CMC joint was torn.We thought it had been dislocated to the volar side and spontaneously reduced to that position.There are only few reports of volar dislocation of CMC joint fractures,particularly of the second and third metacarpals;our report is unique as our patient had an intact interosseous ligament between the second and third metacarpals.CONCLUSION Although past reports have used a palmar approach,the dorsal approach is a good option for these cases.
文摘Double fracture-dislocations of the thumb are rare. Only a single case report of a simultaneous extraarticular fracture of the base of the first metacarpal and dislocation of the metacarpophalangeal joint has been previously reported. We report the second case report of this injury in a 20-year-old man. The patient had an excellent outcome after treatment.
