Multiple volar dislocations of carpometacarpal (CMC) joints are uncommon and have been reported rarely. A 25 years old male presented with injury to his left hand 6 days following a road traffic accident. Clinical examination revealed gross swelling of the hand and diffuse tenderness over the carpometacarpal area. His radiographs of the hand showed volar dislocation of the second, third and fourth CMC joints in association with an extra-articular fracture of the base of thumb metacarpal. He was treated by open reduction and percutaneous fixation using Kirschner wires. The functional results were excellent at one year follow-up.
Adult ; Carpometacarpal Joints ; injuries ; Fractures, Bone ; complications ; Humans ; Joint Dislocations ; complications ; Male ; Metacarpal Bones ; injuries

Double fracture-dislocations of the thumb are rare. Only a single case report of a simultaneous extra- articular 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.
Adult ; Fractures, Bone ; surgery ; Humans ; Joint Dislocations ; surgery ; Male ; Metacarpal Bones ; injuries ; Metacarpophalangeal Joint ; injuries ; Thumb ; injuries

PURPOSE: The purpose of this study was to evaluate clinical results for open reduction and internal fixation of unstable extraarticular metacarpal fractures using low profile titanium plates. METHODS: Sixty-two consecutive patients (76 metacarpals) with unstable extraarticular metacarpal fractures who prospectively underwent internal fixation with plating were enrolled. Minimum follow-up was 1 year. There were 48 males and 14 females; average age was 39 years (range, 15-71 years). The location of the fractures was shaft in 65 metacarpals and the type was transverse in 22 cases, oblique in 46 cases, and communited in 8 cases. Of the 62 patients, 11 were open; 9 of these had additional soft tissue injury. The surgical outcome was assessed by clinical and radiographic outcomes and complications. RESULTS: Bone union was successfully achieved in all patients on the average period of 6.4 weeks. The final range of total active motion was excellent for 64 cases, good for 6 cases, fair for 5 cases, and poor for 1 case. Postoperative complications occurred in 9 patients (15 metacarpals). Statistical analysis revealed that patient age, occupation, multiple metacarpal fractures, and soft tissue injury were significantly correlated with incidence of complications at last follow-up. CONCLUSION: Low profile titanium plating showed the low complication rate and good results in treating unstable extraarticular metacarpal fractures.
Follow-Up Studies ; Humans ; Incidence ; Male ; Metacarpal Bones ; Occupations ; Postoperative Complications ; Prospective Studies ; Soft Tissue Injuries ; Titanium

Adolescent ; Adult ; Bone Nails ; Fracture Fixation ; Fractures, Bone ; surgery ; Humans ; Male ; Metacarpal Bones ; injuries ; surgery ; Middle Aged

OBJECTIVETo study clinical efficacy of manual reduction and traction fixation for the treatment of metacarpal neck fracture under ultrasound-guided.

METHODSFrom April 2013 to August 2016, 30 patients with metacarpal neck fractures were treated with manual reduction and traction fixation under ultrasound-guided, including 26 males and 4 females aged from 14 to 56 years old with an average of (25.6±1.6) years old, the courses of diseases ranged from 7 h to 5 d with an average of (2.7±0.6) d. Twenty patients were the fifth metacarpal neck fracture, 7 patients were the 4th and 5th metacarpal neck fractures, 3 patients were the second metacarpal neck fracture. Fracture healing, angle of bilateral head shaft angle and active range of metacarpophalangeal joints was measured, and DASH score was applied to evaluate function.

RESULTSTwenty-seven patients were followed up from 6 to 11 months with an average of(7.2±0.8) months. Fracture were healed from 5 to 8 weeks with an average of (5.6±0.4) weeks. The affected shaft angle was (15.1±1.8)°, and health head shaft angle was (13.5±2.8)°, while there was no significant difference (=1.54, >0.05). The affected range motion of metacarpophalangealjoint was(86.3±2.6)°, health active range motion of metacarpophalangeal joint was(91.8±1.6)°, and no significant difference between both side (=1.16, >0.05). DASH score was 4.3±1.5 at 7 months after operation.

CONCLUSIONSManual reduction and traction fixation for the treatment of metacarpal neck fracture under ultrasound-guided could dynamic observe fracture position in time, high patients' acceptability and is a feasible method for the treatment of metacarpal neck fracture.

Adult ; Female ; Fracture Healing ; Fractures, Bone ; therapy ; Humans ; Male ; Metacarpal Bones ; injuries ; Traction ; Treatment Outcome ; Ultrasonography ; Young Adult

OBJECTIVE: To compare the clinical efficacy of micro steel plate and Kirschner needle oblique and transverse internal fixation of adjacent metacarpal bone in the treatment of metacarpal diaphyseal oblique fracture. METHODS: Fifty-nine patients with metacarpal diaphyseal oblique fractures admitted between January 2018 and September 2021 were selected as the study subjects and divided into the observation group (29 cases) and the control group (30 cases) based on different internal fixation methods. The observation group was treated with Kirschner wire oblique and transverse internal fixation of adjacent metacarpal bones, while the control group was treated with micro steel plate internal fixation. Postoperative complications, operation time, incision length, fracture healing time, treatment cost, and metacarpophalangeal function were compared between the two groups. RESULTS: No incision or Kirschner wire infections occurred in the 59 patients, except for one in the observation group. No fixation loosening, rupture, or loss of fracture reduction occurred in any of the patients. The operation time and incision length in the observation group were (20.5±4.2) min and (1.6±0.2) cm, respectively, which were significantly shorter than those in the control group (30.8±5.6) min and (4.3±0.8) cm (P<0.05). The treatment cost and fracture healing time in the observation group were (3 804.5±300.8) yuan and (7.2±1.1) weeks, respectively, which were significantly lower than those in the control group (9 906.9±860.6) yuan and (9.3±1.7) weeks (P<0.05). The excellent and good rate of metacarpophalangeal joint function in the observation group was significantly higher than that in the control group at 1, 2, and 3 months after operation (P<0.05), but there was no significant difference between the two groups at 6 months after operation (P>0.05). CONCLUSION Micro steel plate internal fixation and Kirschner wire oblique and transverse internal fixation of adjacent metacarpal bones are both viable surgical methods for treating metacarpal diaphyseal oblique fractures. However, the latter has the advantages of causing less surgical trauma, shorter operation time, better fracture healing, lower cost of fixation materials, and no need for secondary incision and removal of internal fixation.
Humans ; Metacarpal Bones/injuries* ; Fractures, Bone/surgery* ; Fracture Fixation, Internal/methods* ; Bone Wires ; Bone Plates ; Treatment Outcome

OBJECTIVETo introduce a method by reversed ulnar fasciocutaneous flap incised form the ulnar side of the fifth metacarpal area for repairing the soft tissue defect of the fifth finger.

METHODSFrom May 2001 to September 2001, ten patients with the soft tissue defects of the thenar side, dorsal side or ulnar side of the fifth finger were treated with the reversed ulnar fasciocutaneous flap incised from the fifth metacarpal area. The axial line of the flap was the line from ulnar side of the head of the fifth metacarpal bone to the pisiform level. The revolving point of the flap pedicle was 0.5-1 cm near the proximal end of the metacarpal-phalangeal joint.The area of the flap was form 5.0 cm x 3.5 cm to 1.5 cm x 1.0 cm.

RESULTSAll flaps of the ten cases were alive. 5-7 months followed-up show that, after operation, the flap present sensation in 6-12 mm, with soft texture and good appearances.

CONCLUSIONSThe advantages of this operative method were as follows: the reversed ulnar fasciocutaneous flap of the fifth metacarpal area have reliable blood supply, it was easily dissected and with good texture. So far this kind of flap is a good choice in repairing the soft tissue of the fifth finger.

Adolescent ; Adult ; Fascia ; transplantation ; Female ; Finger Injuries ; surgery ; Humans ; Metacarpal Bones ; surgery ; Middle Aged ; Reconstructive Surgical Procedures ; Soft Tissue Injuries ; surgery ; Surgical Flaps ; Young Adult

BACKGROUND: Several techniques have been designed to treat fifth metacarpal fractures reported to be effective. However, these methods cannot be easily applied to the fourth metacarpal due to its central anatomical position. In this study, we sought to analyze the functional outcomes of patients who underwent transverse pinning for a fourth metacarpal bone fracture. METHODS: A total of 21 patients were selected and their charts were retrospectively reviewed. After fracture reduction, two transverse Kirchner wires were first inserted from the fifth metacarpal to the third metacarpal transversely at the distal part of the fractured bone, and then another two wires were inserted at the proximal part of the fractured bone. The splint was removed approximately one week postoperatively and the Kirchner wires were removed four to five weeks postoperatively. Patients started active and passive exercise one week after the operation. Pain visual analog scores, total active and passive motion, and the active and passive range of motion of the metacarpophalangeal joint and grip strength were evaluated. RESULTS: Dorsal angulation improved from a preoperative value of 44.2° to a postoperative value of 5.9°. Six weeks after surgery, functional recovery parameters, such as range of motion and grip strength, had improved to 98% of the function of the normal side. No major complication was observed. CONCLUSIONS: We suggest that the transverse pinning of fourth metacarpal bone fractures is an effective treatment option that is less invasive than other procedures, easy to perform, requires no secondary surgery, minimizes joint and soft tissue injury, and allows early mobilization.
Bone Wires ; Early Ambulation ; Fracture Fixation ; Fractures, Bone* ; Hand Strength ; Humans ; Joints ; Metacarpal Bones ; Metacarpophalangeal Joint ; Range of Motion, Articular ; Retrospective Studies ; Soft Tissue Injuries ; Splints

OBJECTIVETo study the biomechanical characteristics of antegrade intramedullary fixation for metacarpal fractures.

METHODSFrom March to May 2008, both the 4th and 5th metacarpals from 25 formalin embalmed cadaver hands had three-point bending test after transverse osteotomy followed by randomly fixation with one of the following three methods: plate and screw, antegrade intramedullary K-wire, crossed K-wire. While, both the 2nd and 3rd metacarpals had torsional loading test after the same management as the 4th and 5th metacarpal had undergone.

RESULTSIn the three-point bending test, both the maximum bending moment (M(max)) and bending rigidity (EI) of the antegrade intramedullary K-wire were comparable with those of the plate and screw, and were significantly larger than those of the crossed K-wire. In the torsional loading test, the antegrade intramedullary K-wire had a statistically smaller maximum torque (T(max)) than the plate and screw, and had a comparable T(max) with the crossed K-wire; while, the torsional rigidity (GJ) of the intramedullary K-wire was statistically weaker than that of both the plate and screw and the crossed wire.

CONCLUSIONSOne single antegrade intramedullary K-wire can provide a satisfactory M(max) and EI for metacarpal fixation and shows relatively weak in the torsional loading test. The injured finger should be well protected to avoid torsional deformity in clinical practice.

Adult ; Biomechanical Phenomena ; Bone Plates ; Bone Screws ; Bone Wires ; Cadaver ; Fracture Fixation, Internal ; instrumentation ; methods ; Fractures, Bone ; surgery ; Humans ; Metacarpal Bones ; injuries ; Osteotomy

OBJECTIVETo compare the clinical outcomes between two different methods in the treatment of Bennett fractures.

METHODSFrom May 2005 to June 2009, 31 patients with Bennett fractures were treated with gypsum and percutaneous fragment pin fixation. In gypsum fixation group,there were 17 cases including 12 males and 5 females with an average age of (43.9-5.7) years; according to Buechler classification: 3 cases were I region fracture, 11 cases were II region fracture, 3 cases were III region fracture. In percutaneous fragment pin fixation group,there were 14 cases including 8 males and 6 females with an average age of (45.6 +/- 6.1) years; according to Buechler classification: 3 cases were I region fracture, 9 cases were II region fracture and 2 cases were II region fracture. The observing and comparing items of the two groups included: (1) length of stay, time of fracture healing,failure of fixation; (2) postoperative radiographs comparison according to method of Kjaer-Petersen; (3) cannon scores used for outcome measurement.

RESULTSAll the patients in the two groups were followed up, the duration ranged from 6 to 15 months,with an average of (9.0 +/- 3.5) months. The length of stay were (7.0 +/- 2.5) d in gypsum fixation group and (9.0 +/- 3.9) d in percutaneous fragment pin fixation group with statistically significant differences (P < 0.05). The postoperative reduction quality according to method of Kjaer-Petersen, in gypsum fixation group:4 patients got an excellent result, 8 good and 5 poor; in percutaneous fragment pin fixation group,the above data were 8, 6 and 0 respectively;there were statistically significant differences (P < 0.05 ) between the two groups. The time of fracture healing were (6.0 +/- 0.5) weeks in gypsum fixation group and (6.0 +/- 1.9) weeks in percutaneous fragment pin fixation group with no statistically significant differences (P > 0.05). Cannon scores were evaluated at postoperative 3 months,in gypsum fixation group: 6 patients got an excellent result, 8 good and 3 fair; in percutaneous fragment pin fixation group,the above data were 8, 5 and 1 respectively; there were no statistically significant differences (P > 0.05) between two groups. Two patients had fracture re-displacement in gypsum fixation group, and no failure cases in percutaneous fragment pin fixation group.

CONCLUSIONThere are satisfied therapeutic effects in two different methods for the treatment of Bennett fractures. However, gypsum fixation has advantage of easy to operate and atraumatic, but unstability and easy to displacement; percutaneous fragment pin fixation has advantage of fixed solidly and better in functional rehabilitation, but big in surgical trauma and long in length of stay.

Adult ; Case-Control Studies ; External Fixators ; Female ; Fracture Fixation ; methods ; Fractures, Bone ; surgery ; Humans ; Internal Fixators ; Male ; Metacarpal Bones ; injuries ; Middle Aged ; Retrospective Studies