Objective: 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. Methods: 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. Results: 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%. Conclusion: Stability between the fourth and fifth metacarple base is of great significance to the classification and the treatment of the hamate-metacarpal joint injury.

Objective:To explore the clinical classifications and treatments of craniocerebral Langerhans cell histiocytosis (LCH).Methods:Patients with histopathologically conformed LCH in our hospital from January 2008 to January 2019 were classified into 7 types according to the International Histocell Association clinical typing: type I (single site of skull), type II (single site of skull and involvement of central nervous system [CNS]), type III (multiple sites of skull), type IV (single site of CNS), type V (multiple sites of CNS), type VI (low-risk multiple sites of multisystem), and type VII (high-risk multiple sites of multisystem). According to the classification, two treatment methods were adopted. Group A (patients with type I) was treated with local resection, and Group B (patients with type II, III, IV, VI, and VII) was treated with chemotherapy based on Japanese Langerhans Cell Histiocytosis Study Group (JLSG) protocol after local resection or biopsy; according to the efficacy standards of JLSG, the treatment efficacies were evaluated.Results:The study covered 17 patients from Group A (type I) and 29 patients from Group B, including 2 with type II, one with type III, one with type IV, 10 with type VI, and 15 with type VII. During the follow-up period of one-10 years, there was no recurrence in 17 patients from group A; 27 out of 29 patients from group B had effective induction in postoperative JLSG chemotherapy, enjoying induction efficiency of 93.1%; two patients were treated with other chemotherapy regimes, and one of them was followed up for one year and his condition was stable.Conclusion:For type I craniocerebral LCH patients, clinical cure can be obtained with local resection; for type II, III, IV, VI, and VII LCH patients, good curative effect can be obtained with JLSG chemotherapy after local resection or biopsy; for LCH patients who have no reaction or disease progress in the first 6 weeks of induction, the curative effect can be improved by changing the rescue plan in time.