Surgical Fixation of Fourth and Fifth Metacarpal Shaft Fractures with Flexible Intramedullary Absorbable Rods: Early Clinical Outcomes and Implications.

BACKGROUND: To avoid the irritation of tendons and soft tissues as well as hardware-related problems, we designed an intramedullary fixation with bioabsorbable rods for the treatment of the metacarpal shaft fractures. METHODS: Five patients with nine shaft fractures of the fourth and fifth metacarpi were treated with intramedullary absorbable implants and followed up with an average of 4.2 months postoperatively. RESULTS: At final follow-up, all patients achieved fracture union with no signs of inflammatory or subcutaneous effusion. There was no shortening, angulatory, or rotatory deformity. There was almost full active extension range of motion (ROM) of the metacarpophalangeal joints while the active flexion ROM of these joints was 80.7 ± 9.6°. Compared with the contralateral hand, the grip strength of the injured hand was 94.0 ± 9.6%. X-rays showed that the arch of the second to fifth metacarpal heads was smooth. There were no intramedullary lytic changes and soft tissue swellings. CONCLUSION: The intramedullary absorbable implants are a safe, simple, and practical treatment for fourth and fifth metacarpal fractures with good early clinical outcomes and no significant complications.

[Percutaneous retrograde cannulated screw fixation of acute stable scaphoid waist fracture by a transtrapezial approach].

OBJECTIVE: To explore the technique and effectiveness of percutaneous retrograde cannulated screw fixation for acute stable scaphoid waist fracture by a transtrapezial approach. METHODS: Between May 2010 and April 2012, 23 patients with acute stable scaphoid waist fracture were treated with percutaneous retrograde cannulated screw fixation by a transtrapezial approach. There were 18 males and 5 females, aged 21-54 years with an average of 32 years. All fractures were caused by supporting with hands after falling. The locations were the left side in 10 cases and the right side in 13 cases. The major symptoms included the wrist swelling, tenderness at the anatomic snuffbox, and grip weakness. Two cases were accompanied by distal radius fractures. The time between injury and operation ranged from 1 to 5 days with an average of 3 days. RESULTS: All incisions healed by first intention. All the cases were followed up 4-26 months with an average of 10 months. All fractures healed 6-12 weeks postoperatively with an average of 8.2 weeks. The patients resumed normal life and work at 4-6 weeks and at 2-4 months after operation, respectively. At last follow-up, all the wrists were free from the pain and the tenderness. The postoperative grip power ranged from 30 to 51 kg (mean, 37 kg). The active flexion-extension range of motion was 140-165 degrees with an average of 153.7 degrees. All patients were satisfied with the results of treatment. CONCLUSION: Percutaneous retrograde cannulated screw fixation by a transtrapezial approach is a simple, safe, and reliable method to treat acute stable scaphoid waist fracture. By this approach, it is easier to place the screws into the center of the long axis of scaphoid.

[An epidemiological investigation of acute occupational hand injuries].

OBJECTIVE: To study composition, distribution and causes of acute occupational hand injuries in Beijing Jishuitan Hospital. METHODS: From April 1st 2005 to September 30th 2005, all patients with acute hand injuries were investigated by questionnaire focusing on all related epidemiological elements. RESULTS: Two thousand six hundred fifty eight cases with acute hand injuries were about 17.3 % of patients with acute orthopedic injuries. Their mean age was (30.4 +/- 10.8) years old. The radio of males to females in cases with acute hand injuries was 57:1. The cutting and crushing injuries were the main causes of acute hand injuries. Most of cases with acute hand injuries were engaged in work related to machines. The acute hand injuries were mainly involved in index and middle figures of both hands, 94.9 % of acute hand injuries were opening, and 87.6% of acute hand injuries were involved in the deep tissues. CONCLUSION: Acute hand injuries are the common occupational severe injuries for young male workers. The acute hand injuries occur in patients engaged in work related to machines. The prevention of acute hand injuries should be emphasized.

Clinical classification and treatment strategy of hamate hook fracture.

To explore the clinical classification of hamate hook fracture and the treatment strategy for different type of fractures, 12 patients who suffered from hamate hook fractures were followed up retrospectively. According to the fracture sites and the prognosis, we classified the hamate hook fractures into 3 types. Type I referred to an avulsion fracture at the tip of hamate hook, type II was a fracture in the middle part of hamate hook, and type III represented a fracture at the base of hamate hook. By the classification, in our series, only 1 fell into type I, 7 type II, and 4 type III. The results were evaluated with respect to the functional recovery, recovery time and the association among the clinical classification, pre-operative complications and treatment results. The average follow-up time of this group was 8.4±3.9 months. Two cases were found to have fracture non-union and both of them were type II fractures. Six patients had complications before operation. Five cases were type II fractures and 1 case type III fracture. All the patients were satisfied with the results at the time of the last follow-up. Their pain scale and grip strength improved significantly after treatment. All the pre-operative complications were relieved. The recovery time of hamate hook excision was significantly shorter than that of the other two treatments. The incidences of both pre-operative complications and non-union in type II fractures were higher than those in type I and type III fractures. It was concluded that, generally, the treatment effects with hamate hook fracture are quite good. The complication incidence and prognosis of the fracture are closely related to the clinical classification. Early intervention is critical for type II fractures.