Pub Date : 2020-04-10DOI: 10.3760/CMA.J.CN311653-20191205-06370
Ying Zhao, Tingsong Jia, Jing-bo Liu, Kaiming Gao, J. Lao
Objective To investigate the clinical efficacy of external fixators in the treatment of intra-articular fractures of the metacarpal and phalangeal bones. Methods From February 2012 to September 2017, a total of 30 patients with intra-articular metacarpal or phalangeal fractures (30 fingers) were treated by external fixators (combined with limited internal fixation using Kirschner wire in some cases). X-ray films were taken at the first day, the first week and the second week after operation. If necessary, the external fixator could be adjusted again according to the results of X-ray films to achieve better reduction of the fractures. Results The follow-up period ranged from 6 to 72 months with an average of 22 months. Follow-up lost occurred in 1 case after removal of the external fixator. The average clinical healing time of fracture was 7 weeks. After operation, 1 case had loosening of fixation pin, 1 case had severe pain, 4 cases had joint stiffness, 1 case had malunion of fracture, 1 case had damage of articular surface and obviously narrow joint space, 4 cases had poor tolerance to cold stimulation. In the last follow-up, total active motion (TAM) was used to evaluate the function. The results were rated as excellent in 15 cases, good in 5 cases, fair in 7 cases and poor in 2 cases, with the excellent and good rate being 69%. The mean DASH score was 4.2 and the average postoperative 6 weeks could return to work and daily life. Conclusion External fixator (combined with limited internal fixation using Kirschner wire in some cases) is an effective and safe method for the treatment of intra-articular fractures of the metacarpal and phalangeal bones. Key words: Metacarpal bones; Finger phalanges; Intra-articular fracture; External fixator
{"title":"Management of intra-articular metacarpal and phalangeal fractures with external fixators","authors":"Ying Zhao, Tingsong Jia, Jing-bo Liu, Kaiming Gao, J. Lao","doi":"10.3760/CMA.J.CN311653-20191205-06370","DOIUrl":"https://doi.org/10.3760/CMA.J.CN311653-20191205-06370","url":null,"abstract":"Objective \u0000To investigate the clinical efficacy of external fixators in the treatment of intra-articular fractures of the metacarpal and phalangeal bones. \u0000 \u0000 \u0000Methods \u0000From February 2012 to September 2017, a total of 30 patients with intra-articular metacarpal or phalangeal fractures (30 fingers) were treated by external fixators (combined with limited internal fixation using Kirschner wire in some cases). X-ray films were taken at the first day, the first week and the second week after operation. If necessary, the external fixator could be adjusted again according to the results of X-ray films to achieve better reduction of the fractures. \u0000 \u0000 \u0000Results \u0000The follow-up period ranged from 6 to 72 months with an average of 22 months. Follow-up lost occurred in 1 case after removal of the external fixator. The average clinical healing time of fracture was 7 weeks. After operation, 1 case had loosening of fixation pin, 1 case had severe pain, 4 cases had joint stiffness, 1 case had malunion of fracture, 1 case had damage of articular surface and obviously narrow joint space, 4 cases had poor tolerance to cold stimulation. In the last follow-up, total active motion (TAM) was used to evaluate the function. The results were rated as excellent in 15 cases, good in 5 cases, fair in 7 cases and poor in 2 cases, with the excellent and good rate being 69%. The mean DASH score was 4.2 and the average postoperative 6 weeks could return to work and daily life. \u0000 \u0000 \u0000Conclusion \u0000External fixator (combined with limited internal fixation using Kirschner wire in some cases) is an effective and safe method for the treatment of intra-articular fractures of the metacarpal and phalangeal bones. \u0000 \u0000 \u0000Key words: \u0000Metacarpal bones; Finger phalanges; Intra-articular fracture; External fixator","PeriodicalId":67383,"journal":{"name":"中华手外科杂志","volume":"36 1","pages":"119-121"},"PeriodicalIF":0.0,"publicationDate":"2020-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43202964","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-04-10DOI: 10.3760/CMA.J.CN311653-20190305-00058
Weijian Chen, B. Liu, Liang Lu, Jianxue Zeng
Objective To report the feasibility and efficacy of the treatment of open fracture of the distal phalanx with nail bed injury. Methods From June 2016 to August 2018, 28 patients with open fracture of the distal phalanx of 34 fingers with nail bed injury admitted to the emergency department of our hospital were treated. After thorough debridement, one or two No.7 syringe needles were used to screw from the bottom or side of nail bed through the fingertip, and the fracture end was fixed by intramedullary fixation under direct vision. After nail bed reduction in situ without suture, nail template was made with 5 ml syringe barrel (if the original nail was intact, it could be trimmed and replanted) and covered the surface of the nail bed. The nail template was removed 3 weeks after operation, and the syringe needle was removed 4 to 6 weeks after operation to observe fracture healing and nail growth. Results All the patients were follow-up for 3 to 18 months, and all wounds achieved primary healing. No infection or nonunion occurred. The nail regeneration was evaluated as excellent in 25 fingers, good in 6 fingers, fair in 2 fingers, and poor in 1 finger, with the excellent and good rate being 91.2%. The finger flexion and extension function was rated as excellent in 26 fingers, good in 4 fingers, fair in 3 fingers, and poor in 1 finger, with the excellent and good rate being 88.2%. Conclusion The method of fixing the fracture of the distal phalanx with syringe needle is reliable. The nail template made by syringe needle barrel covering the lacerated nail bed is simple and effective in preventing nail deformity after operation. Key words: Finger phalanges; Fractures,bone; Nail bed; Syringe needle; Nail template
{"title":"Treatment of open fracture of the distal phalanx with syringe needle and nail template","authors":"Weijian Chen, B. Liu, Liang Lu, Jianxue Zeng","doi":"10.3760/CMA.J.CN311653-20190305-00058","DOIUrl":"https://doi.org/10.3760/CMA.J.CN311653-20190305-00058","url":null,"abstract":"Objective \u0000To report the feasibility and efficacy of the treatment of open fracture of the distal phalanx with nail bed injury. \u0000 \u0000 \u0000Methods \u0000From June 2016 to August 2018, 28 patients with open fracture of the distal phalanx of 34 fingers with nail bed injury admitted to the emergency department of our hospital were treated. After thorough debridement, one or two No.7 syringe needles were used to screw from the bottom or side of nail bed through the fingertip, and the fracture end was fixed by intramedullary fixation under direct vision. After nail bed reduction in situ without suture, nail template was made with 5 ml syringe barrel (if the original nail was intact, it could be trimmed and replanted) and covered the surface of the nail bed. The nail template was removed 3 weeks after operation, and the syringe needle was removed 4 to 6 weeks after operation to observe fracture healing and nail growth. \u0000 \u0000 \u0000Results \u0000All the patients were follow-up for 3 to 18 months, and all wounds achieved primary healing. No infection or nonunion occurred. The nail regeneration was evaluated as excellent in 25 fingers, good in 6 fingers, fair in 2 fingers, and poor in 1 finger, with the excellent and good rate being 91.2%. The finger flexion and extension function was rated as excellent in 26 fingers, good in 4 fingers, fair in 3 fingers, and poor in 1 finger, with the excellent and good rate being 88.2%. \u0000 \u0000 \u0000Conclusion \u0000The method of fixing the fracture of the distal phalanx with syringe needle is reliable. The nail template made by syringe needle barrel covering the lacerated nail bed is simple and effective in preventing nail deformity after operation. \u0000 \u0000 \u0000Key words: \u0000Finger phalanges; Fractures,bone; Nail bed; Syringe needle; Nail template","PeriodicalId":67383,"journal":{"name":"中华手外科杂志","volume":"36 1","pages":"85-87"},"PeriodicalIF":0.0,"publicationDate":"2020-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46624661","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-04-10DOI: 10.3760/CMA.J.CN311653-20190828-00242
Xin Zhou, Dong Liu, Changliang Ou, Guanghui Wu, Lin Luo, Yonggen Zou
Objective To investigate the clinical application and efficacy of medial plantar venous flap with sensory nerves for repair of distal digital pulp defects. Methods From May 2015 to October 2018, 14 cases (21 fingers) of distal digital pulp defects were treated by the medial plantar venous flap with sensory nerves. The defect area ranged from 1.8 cm×0.6 cm to 2.9 cm×2.1 cm. The flap was designed to contain at least one medial cutaneous branch of saphenous nerve or medial cutaneous branch of plantar nerve. The donor area was covered with full-thick skin graft or directly sutured. Results All the flaps survived. All the grafts in the donor area achieved primary healing. The scar flexion contracture deformity of fingers occurred in 2 cases, and the motion degree of distal interphalangeal joint was more than 60°. The postoperative follow-up time ranged from 4 to 22 months with an average of 12 months. The appearance of the flap was good, and the color and texture were similar to those of the surrounding skin. The flap two-point discrimination was 6.0 to 8.0 mm, with an average of 6.8 mm. According to the upper extremity functional evaluation criteria issued by the Hand Society of the Chinese Medical Association, the finger active motion was rated as excellent in 16 fingers, good in 3 fingers and fair in 2 fingers. According to the sensory evaluation standard issued by British Medical Research Council (1954), the sensory function of flap was S4 in 15 fingers, S3 in 5 fingers and S2 in 1 finger. Conclusion The medial plantar venous flap with sensory nerves is similar to the finger in appearance and texture. It can repair the damaged nerve, reconstruct the sensation and function of the digital pulp, and obtain better clinical efficacy. Key words: Finger injuries; Surgical flaps; Sensory nerve; Venous flap
{"title":"Application of medial plantar venous flap with sensory nerves in the treatment of distal digital pulp defects","authors":"Xin Zhou, Dong Liu, Changliang Ou, Guanghui Wu, Lin Luo, Yonggen Zou","doi":"10.3760/CMA.J.CN311653-20190828-00242","DOIUrl":"https://doi.org/10.3760/CMA.J.CN311653-20190828-00242","url":null,"abstract":"Objective \u0000To investigate the clinical application and efficacy of medial plantar venous flap with sensory nerves for repair of distal digital pulp defects. \u0000 \u0000 \u0000Methods \u0000From May 2015 to October 2018, 14 cases (21 fingers) of distal digital pulp defects were treated by the medial plantar venous flap with sensory nerves. The defect area ranged from 1.8 cm×0.6 cm to 2.9 cm×2.1 cm. The flap was designed to contain at least one medial cutaneous branch of saphenous nerve or medial cutaneous branch of plantar nerve. The donor area was covered with full-thick skin graft or directly sutured. \u0000 \u0000 \u0000Results \u0000All the flaps survived. All the grafts in the donor area achieved primary healing. The scar flexion contracture deformity of fingers occurred in 2 cases, and the motion degree of distal interphalangeal joint was more than 60°. The postoperative follow-up time ranged from 4 to 22 months with an average of 12 months. The appearance of the flap was good, and the color and texture were similar to those of the surrounding skin. The flap two-point discrimination was 6.0 to 8.0 mm, with an average of 6.8 mm. According to the upper extremity functional evaluation criteria issued by the Hand Society of the Chinese Medical Association, the finger active motion was rated as excellent in 16 fingers, good in 3 fingers and fair in 2 fingers. According to the sensory evaluation standard issued by British Medical Research Council (1954), the sensory function of flap was S4 in 15 fingers, S3 in 5 fingers and S2 in 1 finger. \u0000 \u0000 \u0000Conclusion \u0000The medial plantar venous flap with sensory nerves is similar to the finger in appearance and texture. It can repair the damaged nerve, reconstruct the sensation and function of the digital pulp, and obtain better clinical efficacy. \u0000 \u0000 \u0000Key words: \u0000Finger injuries; Surgical flaps; Sensory nerve; Venous flap","PeriodicalId":67383,"journal":{"name":"中华手外科杂志","volume":"36 1","pages":"122-125"},"PeriodicalIF":0.0,"publicationDate":"2020-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44762163","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Objective To compare the clinical efficacy and complications of small transverse and longitudinal incision of the wrist, and the small longitudinal incision of the palm in the treatment of carpal tunnel syndrome (CTS). Methods From June 2015 to June 2018, 150 patients with CTS were diagnosed and treated. There were 50 cases of wrist small transverse incision, 50 cases of wrist small longitudinal incision and 50 cases of longitudinal incision at the root of the palm for carpal tunnel release. The visual analogue scale (VAS), BCTQ score, Kelly's evaluation of clinical efficacy, postoperative complications, neuro-electrophysiological parameters, two-point discrimination and basic operation conditions were compared in three groups at 1, 3 and 6 months after operation. Results There was no significant difference in VAS, BCTQ score and Kelly's evaluation of clinical efficacy and excellent rate between the three groups (P>0.05); the incidence of postoperative scar pain and overall complications in the wrist longitudinal incision group was significantly higher than that in the wrist transverse incision group and the longitudinal incision at the root of the palm (P 0.05). Conclusion The results of three kinds of small incision carpal tunnel release surgery are similar in the treatment of CTS, but the complications of longitudinal incision at the root of the palm and wrist small transverse incision for carpal tunnel release surgery are less. Key words: Carpal tunnel syndrome; Treatment outcome; Small incision; Release
{"title":"A comparative study of carpal tunnel release through three kinds of small incision for the treatment of carpal tunnel syndrome","authors":"Xiaolong Wang, Chaoqian Han, Shu-zheng Wen, Zeng-tao Hao, Jianmin Zhao, Chao Yin, Dongsheng Fan, Shangfei Jing, Yongfei Wang, Jihong Wang, R. Liu","doi":"10.3760/CMA.J.CN311653-20190527-00156","DOIUrl":"https://doi.org/10.3760/CMA.J.CN311653-20190527-00156","url":null,"abstract":"Objective \u0000To compare the clinical efficacy and complications of small transverse and longitudinal incision of the wrist, and the small longitudinal incision of the palm in the treatment of carpal tunnel syndrome (CTS). \u0000 \u0000 \u0000Methods \u0000From June 2015 to June 2018, 150 patients with CTS were diagnosed and treated. There were 50 cases of wrist small transverse incision, 50 cases of wrist small longitudinal incision and 50 cases of longitudinal incision at the root of the palm for carpal tunnel release. The visual analogue scale (VAS), BCTQ score, Kelly's evaluation of clinical efficacy, postoperative complications, neuro-electrophysiological parameters, two-point discrimination and basic operation conditions were compared in three groups at 1, 3 and 6 months after operation. \u0000 \u0000 \u0000Results \u0000There was no significant difference in VAS, BCTQ score and Kelly's evaluation of clinical efficacy and excellent rate between the three groups (P>0.05); the incidence of postoperative scar pain and overall complications in the wrist longitudinal incision group was significantly higher than that in the wrist transverse incision group and the longitudinal incision at the root of the palm (P 0.05). \u0000 \u0000 \u0000Conclusion \u0000The results of three kinds of small incision carpal tunnel release surgery are similar in the treatment of CTS, but the complications of longitudinal incision at the root of the palm and wrist small transverse incision for carpal tunnel release surgery are less. \u0000 \u0000 \u0000Key words: \u0000Carpal tunnel syndrome; Treatment outcome; Small incision; Release","PeriodicalId":67383,"journal":{"name":"中华手外科杂志","volume":"36 1","pages":"106-110"},"PeriodicalIF":0.0,"publicationDate":"2020-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44468803","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-04-10DOI: 10.3760/CMA.J.CN311653-20191219-06369
Hu Yu, Yu-zhou Liu, J. Lao
Objective To explore the early and mid-term electrophysiological recovery of the contralateral C7 nerve transfer using the medial antebrachial cutaneous nerve to bridge the deep branch of ulnar nerve. Methods From July 2016 to June 2017, 40 patients with total brachial plexus injury were treated, of which 20 cases were treated with the repair of median nerve and deep branch of ulnar nerve through the bridge of pedicled ulnar nerve and medial cutaneous nerve of forearm (experimental group), and 20 cases were treated with the repair of median nerve through the bridge of pedicled ulnar nerve (control group). The early electrophysiological recovery of abductor pollicis brevis, abductor digiti minimis and dorsal interosseous muscles in the affected side was evaluated by electromyography (EMG) examination. Results The follow-up time was 19 to 30 months with an average of 24.9 months. In the control group, motor unit potential (MUP) could be recorded in abductor pollicis brevis in 4 cases, a small amount of recruitment phase, and compound muscle action potential (CMAP) could be recorded in abductor pollicis brevis in 1 case. MUP could not be recorded in abductor digiti minimi and dorsal interosseous muscles in all the patients. In the experimental group, a small amount of MUP could be recorded in abductor pollicis brevis in 5 cases, CAMP could be recorded in abductor pollicis brevis in 2 cases. A small amount of MUP could be recorded in the abductor digiti minimi in 5 cases, in the dorsal interosseous muscle in 2 cases, and CAMP could be recorded in abductor digiti minimi and dorsal interosseous muscles in 1 case. There was significant difference between the two groups in the recovery of MUP of abductor digiti minimi (P 0.05). Conclusion The contralateral C7 nerve transfer by bridging medial antebrachial cutaneous nerve to deep branch of ulnar nerve was confirmed electrophysiologically that the function of intrinsic hand muscles achieved early recovery in the patients with total brachial plexus injury without affecting the recovery of median nerve. Key words: Brachial plexus; Nerve transfer; Contralateral C7 nerve root; Medial antebrachial cutaneous nerve; Deep branch of ulnar nerve
{"title":"Early and mid-term electrophysiological study of the contralateral C7 nerve transfer using the medial antebrachial cutaneous nerve as a bridge to the deep branch of ulnar nerve","authors":"Hu Yu, Yu-zhou Liu, J. Lao","doi":"10.3760/CMA.J.CN311653-20191219-06369","DOIUrl":"https://doi.org/10.3760/CMA.J.CN311653-20191219-06369","url":null,"abstract":"Objective \u0000To explore the early and mid-term electrophysiological recovery of the contralateral C7 nerve transfer using the medial antebrachial cutaneous nerve to bridge the deep branch of ulnar nerve. \u0000 \u0000 \u0000Methods \u0000From July 2016 to June 2017, 40 patients with total brachial plexus injury were treated, of which 20 cases were treated with the repair of median nerve and deep branch of ulnar nerve through the bridge of pedicled ulnar nerve and medial cutaneous nerve of forearm (experimental group), and 20 cases were treated with the repair of median nerve through the bridge of pedicled ulnar nerve (control group). The early electrophysiological recovery of abductor pollicis brevis, abductor digiti minimis and dorsal interosseous muscles in the affected side was evaluated by electromyography (EMG) examination. \u0000 \u0000 \u0000Results \u0000The follow-up time was 19 to 30 months with an average of 24.9 months. In the control group, motor unit potential (MUP) could be recorded in abductor pollicis brevis in 4 cases, a small amount of recruitment phase, and compound muscle action potential (CMAP) could be recorded in abductor pollicis brevis in 1 case. MUP could not be recorded in abductor digiti minimi and dorsal interosseous muscles in all the patients. In the experimental group, a small amount of MUP could be recorded in abductor pollicis brevis in 5 cases, CAMP could be recorded in abductor pollicis brevis in 2 cases. A small amount of MUP could be recorded in the abductor digiti minimi in 5 cases, in the dorsal interosseous muscle in 2 cases, and CAMP could be recorded in abductor digiti minimi and dorsal interosseous muscles in 1 case. There was significant difference between the two groups in the recovery of MUP of abductor digiti minimi (P 0.05). \u0000 \u0000 \u0000Conclusion \u0000The contralateral C7 nerve transfer by bridging medial antebrachial cutaneous nerve to deep branch of ulnar nerve was confirmed electrophysiologically that the function of intrinsic hand muscles achieved early recovery in the patients with total brachial plexus injury without affecting the recovery of median nerve. \u0000 \u0000 \u0000Key words: \u0000Brachial plexus; Nerve transfer; Contralateral C7 nerve root; Medial antebrachial cutaneous nerve; Deep branch of ulnar nerve","PeriodicalId":67383,"journal":{"name":"中华手外科杂志","volume":"36 1","pages":"95-98"},"PeriodicalIF":0.0,"publicationDate":"2020-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43283273","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-04-10DOI: 10.3760/CMA.J.CN311653-20190505-05996
Jun Wang, Hongwei Li, C. Bai, Dawei Li, Zhiru Wang
Objective To explore the clinical efficacy of microsurgical replantation of retrograde avulsion of finger skin. Methods From June 2013 to June 2018, 12 cases of retrograde avulsion injury of fingers were treated by the repair of fracture dislocation, skin replantation and repair of blood vessels, nerves and tendons. After operation, anti-inflammatory, anticoagulant and antispasmodic treatment were performed. They were absolutely in bed and kept warm. The blood supply, sensation and functional recovery of replanted skin were observed. Results The skin of fingers survived well in 10 cases, and a small amount of skin necrosis and scab formed in 2 cases. The wound healed well after active dressing change and scab removal. The follow-up time ranged from 6 to 12 months. 12 patients had good hand shape, soft skin, sufficient blood supply and good finger function. The total activity of flexion and extension of interphalangeal joint and metacarpophalangeal joint of the affected side were compared with those of the healthy side. According to the evaluation standard of hand function, the results were rated as excellent in 7 cases, good in 2 cases and fair 3 cases. The skin sensation recovered to S4 in 5 cases, S3 in 4 cases, S2 in 2 cases and S1 in 1 case. Conclusion The microsurgical replantation of retrograde avulsion of finger skin can reduce the necrosis rate of avulsion skin and retain the shape and function of finger to the maximum extent, which is a method worthy of reference. Key words: Finger injuries; Microsurgery; Retrograde avulsion injury; Replantation
{"title":"Microsurgical replantation of retrograde avulsion injury of finger skin","authors":"Jun Wang, Hongwei Li, C. Bai, Dawei Li, Zhiru Wang","doi":"10.3760/CMA.J.CN311653-20190505-05996","DOIUrl":"https://doi.org/10.3760/CMA.J.CN311653-20190505-05996","url":null,"abstract":"Objective \u0000To explore the clinical efficacy of microsurgical replantation of retrograde avulsion of finger skin. \u0000 \u0000 \u0000Methods \u0000From June 2013 to June 2018, 12 cases of retrograde avulsion injury of fingers were treated by the repair of fracture dislocation, skin replantation and repair of blood vessels, nerves and tendons. After operation, anti-inflammatory, anticoagulant and antispasmodic treatment were performed. They were absolutely in bed and kept warm. The blood supply, sensation and functional recovery of replanted skin were observed. \u0000 \u0000 \u0000Results \u0000The skin of fingers survived well in 10 cases, and a small amount of skin necrosis and scab formed in 2 cases. The wound healed well after active dressing change and scab removal. The follow-up time ranged from 6 to 12 months. 12 patients had good hand shape, soft skin, sufficient blood supply and good finger function. The total activity of flexion and extension of interphalangeal joint and metacarpophalangeal joint of the affected side were compared with those of the healthy side. According to the evaluation standard of hand function, the results were rated as excellent in 7 cases, good in 2 cases and fair 3 cases. The skin sensation recovered to S4 in 5 cases, S3 in 4 cases, S2 in 2 cases and S1 in 1 case. \u0000 \u0000 \u0000Conclusion \u0000The microsurgical replantation of retrograde avulsion of finger skin can reduce the necrosis rate of avulsion skin and retain the shape and function of finger to the maximum extent, which is a method worthy of reference. \u0000 \u0000 \u0000Key words: \u0000Finger injuries; Microsurgery; Retrograde avulsion injury; Replantation","PeriodicalId":67383,"journal":{"name":"中华手外科杂志","volume":"36 1","pages":"92-94"},"PeriodicalIF":0.0,"publicationDate":"2020-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42750915","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-04-10DOI: 10.3760/CMA.J.CN311653-20190905-00252
Junming Li, Yan-hua Li, Wei Wang, He-jun Huang, Xiaoguang Zhang, P. Dai, G. Ma, Dao-xuan Li
Objective To investigate the application and clinical efficacy of pulley forceps in the surgical treatment of basal fractures of the first metacarpal bone involving carpometacarpal joint. Methods From June 2014 to December 2018, 14 cases of basal fractures of the first metacarpal bone involving carpometacarpal joint were treated. The space between abductor pollicis longus tendon and extensor pollicis brevis tendon was served as the first operative window. The fracture end and carpometacarpal joint of thumb were exposed. The periosteum was cut on the ulnar side of the extensor pollicis brevis tendon served as the second operative window. C-shaped pulley forceps was placed on the volar and ulnar side of the bone fragments. The bone fragments were hooked and controlled. The first metacarpal bone was pulled and pronated by an assistant. Under direct vision, anatomical reduction of bone fragments can be seen. Kirschner wire with a diameter of 1.0 or 1.2 mm was used to fix the fracture and carpometacarpal joint of thumb at the second and first operation windows respectively. After 4 weeks of plaster fixation, Kirschner wire was removed which was used for fixation of carpometacarpal joint of thumb and brace was used for fixation. The rehabilitation training of each joint of thumb was done intermittently. After 2 to 3 months, the remaining Kirschner wires were removed according to the fracture healing. Results After operation, all the wounds achieved primary healing. The articular surface was anatomically reduced and the fracture position was good. 10 patients were follow-up for 6 to 36 months. According to Gu Yudong evaluation method of opposition function, all the results were rated as excellent. The movement of carpometacarpal joint of thumb was normal in all directions. The VAS score was 0 in 7 cases, 1 in 1 case and 2 in 2 cases. Conclusion In the operation of the basal fractures of the first metacarpal bone involving carpometacarpal joint, C-shaped pulley forceps can reduce the operation difficulty, simplify the operation and improve the operation efficacy, which has a strong promotion significance. Key words: Fracture fixation; Treatment outcome; Pulley forceps; The base of the first metacarpal bone
{"title":"Application of pulleys forceps in the surgical treatment of basal fractures of the first metacarpal bone involving carpometacarpal joint","authors":"Junming Li, Yan-hua Li, Wei Wang, He-jun Huang, Xiaoguang Zhang, P. Dai, G. Ma, Dao-xuan Li","doi":"10.3760/CMA.J.CN311653-20190905-00252","DOIUrl":"https://doi.org/10.3760/CMA.J.CN311653-20190905-00252","url":null,"abstract":"Objective \u0000To investigate the application and clinical efficacy of pulley forceps in the surgical treatment of basal fractures of the first metacarpal bone involving carpometacarpal joint. \u0000 \u0000 \u0000Methods \u0000From June 2014 to December 2018, 14 cases of basal fractures of the first metacarpal bone involving carpometacarpal joint were treated. The space between abductor pollicis longus tendon and extensor pollicis brevis tendon was served as the first operative window. The fracture end and carpometacarpal joint of thumb were exposed. The periosteum was cut on the ulnar side of the extensor pollicis brevis tendon served as the second operative window. C-shaped pulley forceps was placed on the volar and ulnar side of the bone fragments. The bone fragments were hooked and controlled. The first metacarpal bone was pulled and pronated by an assistant. Under direct vision, anatomical reduction of bone fragments can be seen. Kirschner wire with a diameter of 1.0 or 1.2 mm was used to fix the fracture and carpometacarpal joint of thumb at the second and first operation windows respectively. After 4 weeks of plaster fixation, Kirschner wire was removed which was used for fixation of carpometacarpal joint of thumb and brace was used for fixation. The rehabilitation training of each joint of thumb was done intermittently. After 2 to 3 months, the remaining Kirschner wires were removed according to the fracture healing. \u0000 \u0000 \u0000Results \u0000After operation, all the wounds achieved primary healing. The articular surface was anatomically reduced and the fracture position was good. 10 patients were follow-up for 6 to 36 months. According to Gu Yudong evaluation method of opposition function, all the results were rated as excellent. The movement of carpometacarpal joint of thumb was normal in all directions. The VAS score was 0 in 7 cases, 1 in 1 case and 2 in 2 cases. \u0000 \u0000 \u0000Conclusion \u0000In the operation of the basal fractures of the first metacarpal bone involving carpometacarpal joint, C-shaped pulley forceps can reduce the operation difficulty, simplify the operation and improve the operation efficacy, which has a strong promotion significance. \u0000 \u0000 \u0000Key words: \u0000Fracture fixation; Treatment outcome; Pulley forceps; The base of the first metacarpal bone","PeriodicalId":67383,"journal":{"name":"中华手外科杂志","volume":"36 1","pages":"88-91"},"PeriodicalIF":0.0,"publicationDate":"2020-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45775774","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-04-10DOI: 10.3760/CMA.J.CN311653-20191122-06329
Yue Zhang, Qin Shao, L. Fang, Chunhua Chen, Chen-song Yang, Zhao Jinglei, Guixin Sun
Objective To investigate the clinical efficacy of double plate fixation in the treatment of distal radius fracture combined with ulnar head fracture. Methods From March 2014 to August 2017, 16 cases of distal radius fracture combined with ulnar head fracture were treated with open reduction and double plate fixation. Postoperative active rehabilitation exercise was performed after operation. According to the general situation of patients, postoperative radiographic parameters and Gartland-Werley wrist score, the operation effect was evaluated. The feasibility, indications and key points of this method in the treatment of distal radius fracture combined with ulnar head fracture were analyzed. Results Fourteen patients were follow-up and 2 patients were lost. The follow-up period ranged from 12 to 15 months with an average of 13 months. The radiographic results showed that all the fractures healed and achieved anatomical reduction. According to Gartland-Werley wrist score, the results were rated as excellent in 10 cases, good in 2 cases, fair in 2 cases. The average angle of the affected wrist was (69.51±1.97)° in flexion, (70.26±2.71)° in extension, (76.55±3.41)° in pronation and (71.35±1.54)° in supination. There was no significant difference in range of motion between the affected side and the healthy side (P>0.05). Conclusion The function of the wrist recovered well after the treatment of distal radius fracture combined with ulnar head fracture with double plate fixation, which is worthy of clinical application. Key words: Radius fractures; Treatment outcome; Double plate fixation; Ulnar head
{"title":"Clinical efficacy analysis of double plate fixation in the treatment of distal radius fracture combined with ulnar head fracture","authors":"Yue Zhang, Qin Shao, L. Fang, Chunhua Chen, Chen-song Yang, Zhao Jinglei, Guixin Sun","doi":"10.3760/CMA.J.CN311653-20191122-06329","DOIUrl":"https://doi.org/10.3760/CMA.J.CN311653-20191122-06329","url":null,"abstract":"Objective \u0000To investigate the clinical efficacy of double plate fixation in the treatment of distal radius fracture combined with ulnar head fracture. \u0000 \u0000 \u0000Methods \u0000From March 2014 to August 2017, 16 cases of distal radius fracture combined with ulnar head fracture were treated with open reduction and double plate fixation. Postoperative active rehabilitation exercise was performed after operation. According to the general situation of patients, postoperative radiographic parameters and Gartland-Werley wrist score, the operation effect was evaluated. The feasibility, indications and key points of this method in the treatment of distal radius fracture combined with ulnar head fracture were analyzed. \u0000 \u0000 \u0000Results \u0000Fourteen patients were follow-up and 2 patients were lost. The follow-up period ranged from 12 to 15 months with an average of 13 months. The radiographic results showed that all the fractures healed and achieved anatomical reduction. According to Gartland-Werley wrist score, the results were rated as excellent in 10 cases, good in 2 cases, fair in 2 cases. The average angle of the affected wrist was (69.51±1.97)° in flexion, (70.26±2.71)° in extension, (76.55±3.41)° in pronation and (71.35±1.54)° in supination. There was no significant difference in range of motion between the affected side and the healthy side (P>0.05). \u0000 \u0000 \u0000Conclusion \u0000The function of the wrist recovered well after the treatment of distal radius fracture combined with ulnar head fracture with double plate fixation, which is worthy of clinical application. \u0000 \u0000 \u0000Key words: \u0000Radius fractures; Treatment outcome; Double plate fixation; Ulnar head","PeriodicalId":67383,"journal":{"name":"中华手外科杂志","volume":"36 1","pages":"81-84"},"PeriodicalIF":0.0,"publicationDate":"2020-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46301179","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-04-10DOI: 10.3760/CMA.J.CN311653-20190322-00081
Zhe Zhu, Di You, Wenlai Guo, Chao Huang, Rui Li, Zuofeng Wang, Jiahui Lin
Objective To evaluate the clinical efficacy of simple joint debridement in the treatment of distal interphalangeal joint mucocele. Methods From April 2013 to September 2017, 12 patients with 15 fingers of distal interphalangeal joint or thumb interphalangeal joint mucocele were treated by joint debridement. The dorsal joint capsule and osteophyte were removed during the operation. Results One finger had partial necrosis of the incision skin and healed after dressing change. The incision skin of the rest fingers achieved primary healing. The postoperative follow-up ranged from 14 to 22 months with an average of 15.5 months. No recurrence of cyst and rupture of extensor tendon were found. The range of motion of the affected finger joint was significantly increased and the pain of the joint movement was alleviated. Conclusion The simple interphalangeal joint debridement through dorsal approach without cyst wall removal can avoid skin grafting and skin flap treatment. It has the advantages of low recurrence rate and good joint activity. It can be widely used in clinic. Key words: Mucocele; Osteophyte; Interphalangeal joint; Joint debridement
{"title":"Application of joint debridement for distal interphalangeal joint mucocele","authors":"Zhe Zhu, Di You, Wenlai Guo, Chao Huang, Rui Li, Zuofeng Wang, Jiahui Lin","doi":"10.3760/CMA.J.CN311653-20190322-00081","DOIUrl":"https://doi.org/10.3760/CMA.J.CN311653-20190322-00081","url":null,"abstract":"Objective \u0000To evaluate the clinical efficacy of simple joint debridement in the treatment of distal interphalangeal joint mucocele. \u0000 \u0000 \u0000Methods \u0000From April 2013 to September 2017, 12 patients with 15 fingers of distal interphalangeal joint or thumb interphalangeal joint mucocele were treated by joint debridement. The dorsal joint capsule and osteophyte were removed during the operation. \u0000 \u0000 \u0000Results \u0000One finger had partial necrosis of the incision skin and healed after dressing change. The incision skin of the rest fingers achieved primary healing. The postoperative follow-up ranged from 14 to 22 months with an average of 15.5 months. No recurrence of cyst and rupture of extensor tendon were found. The range of motion of the affected finger joint was significantly increased and the pain of the joint movement was alleviated. \u0000 \u0000 \u0000Conclusion \u0000The simple interphalangeal joint debridement through dorsal approach without cyst wall removal can avoid skin grafting and skin flap treatment. It has the advantages of low recurrence rate and good joint activity. It can be widely used in clinic. \u0000 \u0000 \u0000Key words: \u0000Mucocele; Osteophyte; Interphalangeal joint; Joint debridement","PeriodicalId":67383,"journal":{"name":"中华手外科杂志","volume":"36 1","pages":"103-105"},"PeriodicalIF":0.0,"publicationDate":"2020-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43869641","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-04-10DOI: 10.3760/CMA.J.CN311653-20190916-00264
Shuang Li, Ai-dong Deng, X. Gu, Jialing Gao, Dan Liu, Z. Qian, J. Gu, Guheng Wang
Objective To provide reference data for clinical and biomechanical research through drawing the fracture morphology of type C distal radius fracture and the length of distal radioulnar ligament by fracture mapping technology. Methods From January 2018 to December 2018, 59 cases of OTA/AO 23 C type distal radius fractures were treated in our hospital. Thirty wrist joints of 15 volunteers were used as healthy control group. After thin-layer CT scanning of the wrist joint, the three-dimensional reconstruction was performed by importing the Mimics medical software. The fracture line of the distal radius was introduced into the template after standardization, and the shape of the fracture line was obtained after fitting. The length of the distal radioulnar ligament was obtained by measuring the distance between the sigmoid notch and the base and recess of styloid process of ulna. Results On the radiocarpal joint surface, the fracture line was mainly concentrated around the lunate fossa demonstrated as cross; on the volar side, the fracture line was mainly concentrated around the watery flow line; on the dorsal side, the fracture line was concentrated around Lister's tubercle and scattered; in the area of sigmoid notch, the fracture line was concentrated in the middle 1/3 and dorsal 1/3 of sigmoid notch; in the area of styloid process of radius, it was seen that the styloid process of radius was relatively complete, and the fracture line was distributed under the styloid process of radius. There was no significant difference in the length of the four groups of ligaments, i.e. the volar superficial distal radioulnar ligament, the dorsal superficial distal radioulnar ligament, the volar deep distal radioulnar ligament and the dorsal deep distal radioulnar ligament among the subtypes (C1, C2, C3) of type C distal radius fracture (P>0.05); there was no significant difference between the groups and the healthy control group (n=30, P>0.05). When the fracture line was located in the volar 1/3 and dorsal 1/3 of the sigmoid notch, the length of the palmar superficial distal radioulnar ligament, the dorsal superficial distal radioulnar ligament and the dorsal deep distal radioulnar ligament were significantly different from that of the healthy control group (n=30, P<0.05). Conclusion The fracture pattern of type C distal radius can be visualized by fracture mapping technology. On the radiocarpal joint surface, the fracture line is concentrated around the lunate fossa; in the joint area of sigmoid notch, the fracture line is more concentrated in the middle 1/3 and the dorsal 1/3 of sigmoid notch. When the fracture line is distributed in the volar 1/3 and the dorsal 1/3 of sigmoid notch, it may lead to the risk of distal radioulnar ligament injury. Key words: Radius fractures; Biomechanics; Fracture mapping; Distal radioulnar ligament
目的通过骨折作图技术绘制桡骨远端C型骨折的骨折形态和远端桡尺韧带的长度，为临床和生物力学研究提供参考数据。方法2018年1月至2018年12月在我院治疗OTA/ ao23c型桡骨远端骨折59例。选取15名志愿者30个腕关节作为健康对照组。对腕关节进行薄层CT扫描后，导入Mimics医学软件进行三维重建。标准化后将桡骨远端骨折线引入模板，拟合后得到骨折线形状。测量乙状突切迹与尺骨茎突基部及隐窝之间的距离，获得尺桡韧带远端长度。结果桡腕关节面骨折线主要集中在月骨窝周围，呈十字形;掌侧骨折线主要集中在水流线周围;背侧骨折线集中在李斯特结节周围，散在;在乙状结肠切迹区，骨折线集中在乙状结肠切迹中1/3和背1/3;在桡骨茎突区域，可以看到桡骨茎突发育比较完整，桡骨茎突下方分布有骨折线。C型桡骨远端骨折不同亚型(C1、C2、C3)间掌侧远端桡尺浅韧带、背侧远端桡尺浅韧带、掌侧远端桡尺深韧带、背侧远端桡尺深韧带四组韧带长度差异无统计学意义(P < 0.05);两组与健康对照组比较，差异无统计学意义(n=30, P < 0.05)。当骨折线位于乙状窦切迹掌侧1/3和背侧1/3时，掌侧桡尺远端浅韧带、背侧桡尺远端浅韧带和背侧桡尺远端深韧带的长度与健康对照组相比差异有统计学意义(n=30, P<0.05)。结论骨折作图技术可直观显示C型桡骨远端骨折形态。桡腕关节面骨折线集中在月骨窝周围;在乙状结肠切迹关节区，骨折线多集中在乙状结肠切迹中间1/3和背侧1/3。当骨折线分布在乙状窦切迹掌侧1/3和背侧1/3时，可能导致远端桡尺韧带损伤的风险。关键词:桡骨骨折;生物力学;骨折的映射;远端尺桡韧带
{"title":"Study on the fracture morphology and imaging of distal radioulnar ligament of type C distal radius fracture","authors":"Shuang Li, Ai-dong Deng, X. Gu, Jialing Gao, Dan Liu, Z. Qian, J. Gu, Guheng Wang","doi":"10.3760/CMA.J.CN311653-20190916-00264","DOIUrl":"https://doi.org/10.3760/CMA.J.CN311653-20190916-00264","url":null,"abstract":"Objective \u0000To provide reference data for clinical and biomechanical research through drawing the fracture morphology of type C distal radius fracture and the length of distal radioulnar ligament by fracture mapping technology. \u0000 \u0000 \u0000Methods \u0000From January 2018 to December 2018, 59 cases of OTA/AO 23 C type distal radius fractures were treated in our hospital. Thirty wrist joints of 15 volunteers were used as healthy control group. After thin-layer CT scanning of the wrist joint, the three-dimensional reconstruction was performed by importing the Mimics medical software. The fracture line of the distal radius was introduced into the template after standardization, and the shape of the fracture line was obtained after fitting. The length of the distal radioulnar ligament was obtained by measuring the distance between the sigmoid notch and the base and recess of styloid process of ulna. \u0000 \u0000 \u0000Results \u0000On the radiocarpal joint surface, the fracture line was mainly concentrated around the lunate fossa demonstrated as cross; on the volar side, the fracture line was mainly concentrated around the watery flow line; on the dorsal side, the fracture line was concentrated around Lister's tubercle and scattered; in the area of sigmoid notch, the fracture line was concentrated in the middle 1/3 and dorsal 1/3 of sigmoid notch; in the area of styloid process of radius, it was seen that the styloid process of radius was relatively complete, and the fracture line was distributed under the styloid process of radius. There was no significant difference in the length of the four groups of ligaments, i.e. the volar superficial distal radioulnar ligament, the dorsal superficial distal radioulnar ligament, the volar deep distal radioulnar ligament and the dorsal deep distal radioulnar ligament among the subtypes (C1, C2, C3) of type C distal radius fracture (P>0.05); there was no significant difference between the groups and the healthy control group (n=30, P>0.05). When the fracture line was located in the volar 1/3 and dorsal 1/3 of the sigmoid notch, the length of the palmar superficial distal radioulnar ligament, the dorsal superficial distal radioulnar ligament and the dorsal deep distal radioulnar ligament were significantly different from that of the healthy control group (n=30, P<0.05). \u0000 \u0000 \u0000Conclusion \u0000The fracture pattern of type C distal radius can be visualized by fracture mapping technology. On the radiocarpal joint surface, the fracture line is concentrated around the lunate fossa; in the joint area of sigmoid notch, the fracture line is more concentrated in the middle 1/3 and the dorsal 1/3 of sigmoid notch. When the fracture line is distributed in the volar 1/3 and the dorsal 1/3 of sigmoid notch, it may lead to the risk of distal radioulnar ligament injury. \u0000 \u0000 \u0000Key words: \u0000Radius fractures; Biomechanics; Fracture mapping; Distal radioulnar ligament","PeriodicalId":67383,"journal":{"name":"中华手外科杂志","volume":"36 1","pages":"114-118"},"PeriodicalIF":0.0,"publicationDate":"2020-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46675133","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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