The problem of treatment of the closed tubular hand bones fracture is still the topical one. Hand trauma ranges from 30 to 60% among various injuries when bone fractures make up over 30% including 17.5% of the closed ones. Regardless the high incidence of the pathology, multiple publications and rather large experience of the hand bone fracture repair there is no common method of these fractures management. Currently the following techniques are used: plaster casts, intramedullary nails, metal alloy devices, bone plates and external fixators. Every technique has certain advantages and disadvantages. Universal fixator for small tubular bone is successfully used at Russian Ilizarov Scientific Center “RTO”.
Materials and methods
We evaluated treatment results of the closed hand tubular bones fractures in 118 patients using Ilizarov method. Clinical, radiological and statistical methods were used. Outcomes analysis was performed using software Ms Excel. There was the following distribution of the patients according to the fracture location: II-V metacarpus - 96 cases (81.4%), finger phalanxes - 14 cases (11.8%), 1 metacarpal bone - 8 patients (6.8%). The various techniques and frame assemblies were applied according to the location and character of the fracture.
Anatomical and functional results were evaluated in 118 patients. Good ones were stated in 109 cases (92.4%), satisfactory results were observed in 9 patients and there were no poor results.
Hand tubular bone fractures have some peculiarities. They are very often unstable, with displacement under impact of functionally active structures (flexors and extensors); reduction difficulties appear in comminuted fractures due their small sizes; congruency of the articular surfaces is distorted in intra-articular fractures even without displacement and restoration of ROM is problematic due to scar changes in capsule-ligaments apparatus. The results were considered as good in full restoration of anatomical bone shape and functional possibilities of the hand or in partial ROM limitation due to adjacent joint contractures.
Satisfactory results were in insufficiently fine restoration of the anatomical shape and partial function limitation. Poor results were stated if there was no union.
Therefore, minimal invasiveness of operative intervention, fine and closed reduction, reliable and controllable fixation, joint decompression, simple wire removal and early functional weightbearing allowed us to obtain good functional and anatomical results in treatment of the patients with closed metacarpal fractures using Ilizarov method.Le texte complet de cet article est disponible en PDF.