OBJECTIVES: To study the injury manners of Bennett fracture and Rolando fracture and explore its identification principle of the first metacarpal base fractures. METHODS: Totally 31 cases of Bennett fracture and Rolando fracture were collected. The injury manners of cases of 19 Bennett fractures and 12 Rolando fracture were classified, and various injury manners were analysed statistically. RESULTS: The injury manners of the cases of 19 Bennett fracture and 12 Rolando fracture were divided into three types, including the first metacarpus hit hard objects during a punching, the first metacarpus hit hard objects when making fists and fell, or the first metacarpus was punched by hard objects when making fists. CONCLUSIONS The injury mechanism of Bennett fracture and Rolando fracture is formed by a force on the first metacarpus when making fists, which transmits to the basilar part along the vertical axis of metacarpus. The inference of injury manners should be focused on the confirmation of entrusted matters.
Epiphyses ; Fracture Fixation, Internal/methods* ; Fractures, Bone/surgery* ; Humans ; Joint Dislocations/surgery* ; Metacarpus/injuries* ; Thumb/injuries*

Adolescent ; Adult ; Female ; Fracture Fixation ; methods ; Fractures, Bone ; surgery ; Humans ; Male ; Metacarpus ; injuries ; Middle Aged

OBJECTIVETo investigate the treatment of the displaced neck and subcapital fractures of the fifth metacarpal.

METHODSThirty-one patients with the neck and subcapital fractures of the fifth metacarpal had been operated on with antegrade intramedullary fixation between January and August 2005. There was 11 subcapital fractures (group A), and 20 neck fractures (group B). Following closed reduction of the fracture, a blunt 2.0 mm diameter K-wire, which was pre-bent into 20 degrees at the distal end, was inserted into the medullary canal of the fifth metacarpal and fixed the fractures. Postoperatively, patients in group A were immobilized in a short arm plaster splint for 4 weeks, and the ones in group B were treated with unrestricted mobilization.

RESULTSOperative time was 18 min averagely (range 5 to 30 min). Twenty-nine of 31 patients obtained anatomic reduction, and 2 patients had 2/3 apposition of bone end and no rotational deformity. Follow-up was available for all patients. The average follow-up interval was 4 months, with a range of 3 - 6 months. The head/shaft angle of the fifth metacarpal in group A was 63.4 degrees +/- 14.5 degrees preoperatively, and 15.0 degrees +/- 2.5 degrees postoperatively, and 15.4 degrees +/- 2.6 degrees in 3 months postoperatively. The difference between preoperative and postoperative angles was highly significant. The range of motion of the metacarpal joint was 89.5 degrees +/- 4.3 degrees postoperatively, which was not significantly different compared with that of uninjured side. The head/shaft angle in group B was 59.1 degrees +/- 10.0 degrees preoperatively, and 15.9 degrees +/- 2.5 degrees postoperatively, and 15.5 degrees +/- 2.8 degrees in 3 months postoperatively. The difference between preoperative and postoperative angles was highly significant. The range of motion of the metacarpal joint was 88.6 degrees +/- 3.6 degrees postoperatively, which was not significantly different compared with that of uninjured side.

CONCLUSIONSThe technique is technically easy to perform, minimally invasive, low-cost, allowing early hand mobilization, with good functional results and low morbidity, and it has been proved to be an ideal method.

Adolescent ; Adult ; Follow-Up Studies ; Fracture Fixation, Intramedullary ; methods ; Fractures, Bone ; surgery ; Humans ; Male ; Metacarpus ; injuries ; Treatment Outcome

OBJECTIVETo investigate the reverse island skin flap nourished by the cutaneous nerve nutrient vessel of the dorsum of hand in the repair of the finger deep burn.

METHODSFifteen reverse island skin flaps nourished by the cutaneous nerve nutrient vessel of the dorsum of hand were used to repair finger deep burn in 15 patients. The size of the reverse island skin flap ranged from 5 cm x 3 cm to 3 x 2 cm.

RESULTSAll the flaps survived. Postoperative follow-up showed satisfactory results in appearance, function and aesthesia.

CONCLUSIONSThe reverse island skin flap nourished by the cutaneous nerve nutrient vessel of the dorsum of hand has reliable blood supply, without damage of a known vessel, can meet the demands of fingertip reconstruction. The flap also has the advantages of minor injury of the donor site, easy manipulation and popularization.

Adult ; Burns ; surgery ; Female ; Finger Injuries ; surgery ; Hand Injuries ; surgery ; Humans ; Male ; Metacarpus ; blood supply ; innervation ; Skin Transplantation ; methods ; Surgical Flaps ; blood supply ; Young Adult

We reported a 30 years old man who suffered a bite wound of the right hand in a fight. Two days after the injury, he was admitted in emergency because of stab wound above the head of the third metacarpal bone. He presented the swelling, redness, pain and fever. Primary revision confirmed only partial lesion of the extensor apparatus. During the following days, we recorded a deterioration of local findings and magnetic resonance imaging revealed osteomyelitis and septic arthritis of the thirdmetacarpophalangeal joint. The wound was then revised several times using negative pressure wound therapy in combination with intravenous antibiotics. After resolution of clinical and laboratory findings, the wound was finally closed by delayed primary suture. Clenched fist injury is a medical emergency that requires immediate surgical revision. We treated clenched fist injury with the development of septic arthritis and osteomyelitis with negative pressure wound therapy and obtained good outcomes.
Adult ; Arthritis, Infectious ; etiology ; therapy ; Bites, Human ; complications ; Humans ; Male ; Metacarpophalangeal Joint ; injuries ; Metacarpus ; injuries ; Negative-Pressure Wound Therapy ; Osteomyelitis ; etiology ; therapy

OBJECTIVETo evaluate the clinical application and discuss the operative indication of the reverse dorsal metacarpal flap and its compound flap on the skin defects of hand.

METHODSFrom 1990 to 2003, we applied the reverse dorsal metacarpal flap and its compound flap to repair soft tissue defects of fingers in 122 cases, which included 90 cases of the reverse metacarpal flap and 32 cases of its compound flaps with tendon grafts, nerve grafts or bone grafts. Based on the follow-up observations, we analyzed the indications of the reverse metacarpal flap and its compound flaps, the postoperative contours, flap colors and textures in comparison to contralateral fingers retrospectively.

RESULTSIn the series of 122 cases, flaps survived and the donor site defects were closed directly. The follow-up period ranged from 1-12 years. The postoperative contours, colors and textures of the flaps and its compound flaps were similar to those of normal fingers, although linear scar remained. According to standards of sense recovery (British Medical Research Council, BMRC), the sense function of the flaps resumed S3 after operation for 1 year. In 10 cases with the tendon defects treated by the flap with tendon grafts, function of flexion-extension of fingers resumed 50%-75% in comparison to the contralateral fingers using the method of measurement of total active motion. In 7 cases with the phalangeal nonunion or bone defects treated by the flap with bone grafts, union occurred after operation for 3 months.

CONCLUSIONSTo soft tissue defects on fingers with bone or tendon exposure, the reverse metacarpal flap and its compound flap are a better choice for repairing. The range of repairing is up to the distal interphalangeal joint of fingers. The second dorsal metacarpal artery is more consistent and larger as the choice of vascular pedicle, in comparison with other dorsal metacarpal arteries. Postoperative flap color and texture are similar to normal fingers.

Adolescent ; Adult ; Aged ; Child ; Female ; Finger Injuries ; surgery ; Graft Survival ; Humans ; Male ; Metacarpus ; surgery ; Middle Aged ; Retrospective Studies ; Soft Tissue Injuries ; surgery ; Surgical Flaps ; blood supply ; Treatment Outcome

OBJECTIVETo observe the clinical effects of miniaturized metacarpus steel plate for the treatment of child epiphysis injury, and to analyse its clinical advantages in the child epiphysis injury.

METHODSFrom June 2004 to May 2009, 85 children with epiphysis injury treated with miniaturized metacarpus steel plate included 52 boys and 33 girls with an average age of 6.6 years old ranging from 1 to 14 years. All the children suffered from just one part injury. There were 68 cases of upper limb injury, 19 of which were humerus epicondyle injury, 16 humerus head injury, 12 olecranon injury, 14 distal radius injury and 7 head of radius injury. The other 17 cases were lower limb injury, 12 of which were femur epicondyle injury and 5 tibia epicondyle injury.

RESULTSAll children obtained good intention,and no postoperative complications occurrenced. Eighty-one children were followed up for 6 months to 5 years (averaged 2.6 years). The results were evaluated at 4 weeks after the operation and showed that there were excellent in 44 cases, good in 21 cases, fair in 11 cases and poor in 9 cases.

CONCLUSIONTreatment of child epiphysis injury with miniaturized metacarpus steel plate can achieve perfect anatomical reduction in the early stage, protect the biological environment of the recovery. This treatment makes the postoperative joint functions and movements recovery nice, barely cause any bone malformation, and worth further clinical applications.

Adolescent ; Bone Plates ; Child ; Child, Preschool ; Epiphyses ; diagnostic imaging ; injuries ; surgery ; Female ; Follow-Up Studies ; Humans ; Infant ; Male ; Metacarpus ; Miniaturization ; methods ; Steel ; Tomography, X-Ray Computed ; Treatment Outcome

Injury of the hand has been steadily increasing in this country in recent years, accordingly the proper surgical care for recently injured hand can not be overemphasized. The author has experienced 25 cases of wringer injuries of the hand in the years 1965 to 1971, and the results of the treatment is reported in this paper. 1. 12 cases out of 25 were in age group between 16 to 20 year. 23 cases were male and two cases were female. The incidence was remarkably higher in male. 2. Mode of the injury; All the cases were injured on the joh in factory. 17 cases were injured by a roller machine with or without gears. Four cases were injured by a belt, and three cases were injured by a pressor. 3. Extent of the injury was classified in 10 groups. Avulsion of the skin below the palmar crease were six cases, and below the wrist were in other groups. 4. Fracture and traumatic amputation in the hands were complicated in 16 cases out of 25. 5. 20 cases out of 25 were treated with primary skin repair followed by debridement of the wound. Among them three cases obtained primary healing, and 17 cases had to be treated by repeating surgeries. Five cases out of 25 were treated with delayed primary skin graft, and four cases obtained primary healing. Accordingly the delayed primary skin graft had much better result than primary skin repair in this series. 6. 19 cases out of 25, had surgical amputation in the hands, among them 16 cases had complicated with fracture and traumatic amputation. The incidence of surgical amputation was higher on the proximal phalanx in 33 fingers out of 59 surgically amputated fingers. 7. 23 cases out of 25 were treated by skin graft. The result of primary healing in primary skin graft was three out of 12, and that of secondary skin graft was five out of six, and that of third skin graft was seven out of 10, and that of fourth skin graft was five out of seven, and that of fifth skin graft was one case. Accordingly, the result of primary healing was considerably higher in the group of the secondary skin graft. 18 cases out of 23 of skin graft were split thickness graft, four were full thickness graft and one was full thickness combined with split thickness skin graft. 8. Seven cases of contracture developed in the webs and joints after the healing of the skin graft were treated by web plasty and arthrodesis. One case had had surgical amputation of four fingers at the metacarpophalangeal joints was treated by resection of the second and third metacarpus, which made the hand possibIe to pinch and grasp.
Amputation ; Amputation, Traumatic ; Arthrodesis ; Contracture ; Debridement ; Female ; Fingers ; Hand Strength ; Hand ; Humans ; Incidence ; Joints ; Male ; Metacarpophalangeal Joint ; Metacarpus ; Skin ; Transplants ; Wounds and Injuries ; Wrist

OBJECTIVETo analyze the effects of metacarpus and phalanx traction on correction of scar contracture of hand after burn on the palm side retrospectively.

METHODSA total of 32 patients with 39 affected hands with scar contracture on the palm side after burn were hospitalized from May 2010 to December 2014. Method of treatment: scar contracture was conservatively released followed by skin grafting, which was referred to as method A; Kirschner wire was inserted into the middle or distal phalanx of finger with contracture and the corresponding metacarpus in the shape of U for 2 to 7 weeks' traction, which was referred to as method B; traction frame was built based on the traction pile and anchor formed by Kirschner wire inserted through the second to the fifth metacarpus and distal phalanx of finger with contracture, and then the affected fingers were pulled into a straight position with rubber bands for 2 to 6 months, which was referred to as method C. Method A was used in patients who would be treated with thorough release of scar followed by skin grafting routinely. Method B was used in patients who would be treated with intramedullary Kirschner wire fixation after release of scar contracture and skin transplantation routinely. Method C was further used in patients when methods A and B failed to accomplish the expected result. Method C was used in the first place followed by method A in whom there might be vascular decompensation or exposure of tendon and bone after scar release, and those who failed to meet the expectation were treated with method C in addition. Patients who were unwilling to undergo surgery were treated with method C exclusively. During the course of treatment, the presence or absence of infection and slipping of Kirschner wire or its slitting through soft tissue were observed. The presence or absence of tendency of recurrence of scar contracture within 1 to 2 weeks after treatment was observed. The length of palmar skin measuring from the root of finger with contracture to wrist crease was measured before treatment, at the termination of treatment, and 1 month after the termination of treatment. Scar condition was assessed with the Vancouver Scar Scale (VSS) before treatment and 1, 3, and 6 month(s) after the termination of treatment. Before treatment and 1 month after the termination of treatment, the range of motion was measured with the Total Active Movement (TAM) method; band function was evaluated by the Jebsen Test of Hand Function (JTHF), and the completion time was recorded. Data were processed with analysis of variance, LSD-t test, and t test.

RESULTSTwenty-four patients with 27 affected hands were treated with scheme A + B; 5 patients with 7 affected hands were treated with method C exclusively; 2 patients with 3 affected hands were treated with scheme A + B + C; 1 patient with 2 affected hands were treated with scheme C + A + C. During the course of treatment, no complication such as infection or slicing of tissue was observed, but there was a slight shifting of U-shaped Kirschner wire in 14 affected hands of 13 patients. Tendency of recurrence of scar contracture was observed in 11 affected hands of 10 patients, but the scar contracture did not reoccur after treatment with orthosis. The skin length of palmar side was respectively (131.8 ± 9.8) and (127.6 ± 7.5) mm at the termination of treatment and 1 month after, and they were both significantly longer than that before treatment [(114.5 ± 2.4) mm, with values respectively 10.71 and 10.39, P values below 0.001]. The score of VSS was respectively (9.8 ± 2.4), (9.7 ± 1.7), (9.3 ± 0.8), and (7.7 ± 0.5) points before treatment and 1, 3, and 6 month(s) after the termination of treatment. Only the score at 6 months after the termination of treatment was significantly lower than that before treatment (t = 3.28, P < 0.01). The ratio of excellent and good results according to method TAM was respectively 2.6% (1/39) and 94.9% (37/39) before treatment and 1 month after the termination of treatment. The time for JTHF measurement was (13.9 ± 4.1) min before treatment, and it was shortened to (11.0 ± 2.8) min 1 month after the termination of treatment (t = 3.65, P < 0.001).

CONCLUSIONSSingle application of metacarpus and phalanx traction or its combination with skin transplantation after scar release in correcting scar contracture of the palm of hand after burn can lengthen the contracted tissue, and it is beneficial for the restoration of function and appearance of affected hand.

Burns ; rehabilitation ; therapy ; Cicatrix ; therapy ; Contracture ; surgery ; Hand Injuries ; rehabilitation ; therapy ; Humans ; Metacarpus ; Orthotic Devices ; Range of Motion, Articular ; Reconstructive Surgical Procedures ; methods ; Retrospective Studies ; Skin ; Skin Transplantation ; Tendons ; Time ; Traction ; Treatment Outcome