FUNCTIONAL OUTCOME IN PERCUTANEOUS ELASTIC STABLE INTRAMEDULARY NAILING TECHNIQUE OF METACARPAL BONE FRACTURE

2021 ◽  
pp. 30-32
Author(s):  
Sunil Malhotra ◽  
Mohd. Shifa Hasan ◽  
Arunim Swarup ◽  
Neeraj Kumar Verma
Keyword(s):  
Functional Outcome ◽  
Metacarpal Bone ◽  
Bony Union ◽  
Dash Score ◽  
Metacarpal Fracture ◽  
Active Motion ◽  
Metacarpal Fractures ◽  
Effective Treatment Modality ◽  
Total Active Motion ◽  
Excellent Functional Outcome

AIMS AND OBJECTIVES: The aim of this study was to evaluate functional outcome of metacarpal fractures managed by percutaneous elastic stable intramedullary nails along with its functional outcome. METHOD: The extra-articular metacarpal fracture were managed by inserting two pre-bent elastic stable nails in antegrade manner after making entry point (dorso-medialy and dorso-lateraly) through base of the metacarpal bone. The nails act as three point xation and provide stable xation. Early mobilisation is commenced for providing early healing and decrease postoperative decreased range of motion at metacarpophalangeal/interphalangeal joints and stiffness. Nails were removed 3 week after radiological sign of union. RESULTS: 32 extra-articular metacarpal fractures treated with percutaneous elastic stable nails were evaluated between 1 2 September 2018 to 31 August 2020. The functional outcome was assessed using disability arm shoulder and hand (DASH) score with mean score th 1 of 2 at 6 month follow-up and total active motion (TAM) score which was excellent in 81.2% of the patients (n=26), good in 9.4% of cases (n=3), fair in 9.4% of the cases (n=3).All fracture proceeded to bony union. CONCLUSIONS: It was concluded that indirect reduction and early xation with percutaneous elastic stable intramedullary nailing with 2 nails is very safe and effective treatment modality for extra-articular metacarpal fracture with excellent functional outcome.

Functional Outcome of Closed Metacarpal Fractures Treated with Mini Fragment Plates and Screws

2021 ◽  
Vol 15 (10) ◽  
pp. 2609-2610
Author(s):  
Nouraiz Shakoor ◽  
Umair Ahmed ◽  
Usama Ali Nawazish ◽  
Hisbullah Riaz Ansari ◽  
Sadaf Saddiq ◽  
...  
Keyword(s):  
Cohort Study ◽  
Functional Outcome ◽  
Orthopaedic Surgery ◽  
Early Mobilization ◽  
Open Reduction Internal Fixation ◽  
Metacarpal Fracture ◽  
Metacarpal Fractures ◽  
Active Flexion ◽  
Excellent Functional Outcome ◽  
American Society

Aim: To assess the functional outcome after metacarpal fracture fixation with mini fragment plates. Study design: Prospective cohort study Place and duration of study: Department of Orthopaedic Surgery, GTTH, Lahore from 01-01-2015 to 31-07-2020. Methodology: Sixteen patients who were operated with mini fragment plates for metacarpal fractures. Functional outcome was evaluated with help of American Society for Surgery of the Hand (ASSH) Total Active Flexion (TAF) score and the disabilities of the arm, shoulder. Results: Union was achieved in all patients. The functional outcome was excellent in 13 and good in 2 and poor in 1. Three cases of infection (all superficial) were noted, which settled with dressings and antibiotics. Conclusion: Mini fragment plates for metacarpals fractures are a good option, providing early mobilization and excellent functional outcome. Keywords: Functional outcome, Metacarpal fracture, Mini fragment plat, Open reduction internal fixation (ORIF)

Perkutane, antegrade K-Draht-Osteosynthese bei Fingergrundgliedfrakturen: Vergleich zwischen frühfunktioneller und statischer Nachbehandlung

2021 ◽  
Vol 53 (05) ◽  
pp. 467-474
Author(s):  
Ines Ana Ederer ◽  
Johannes von Fraunberg ◽  
Jonas Kolbenschlag ◽  
Andreas Nusche ◽  
Adrien Daigeler ◽  
...  
Keyword(s):  
Postoperative Komplikationen ◽  
Retrospektive Studie ◽  
Dash Score ◽  
Active Motion ◽  
Fand Sich ◽  
Passive Motion ◽  
Total Active Motion

Zusammenfassung Ziel Diese retrospektive Studie vergleicht die klinischen Ergebnisse der frühfunktionellen Nachbehandlung mit den Ergebnissen mittels 6-wöchiger Schienenruhigstellung nachbehandelter Fingergrundgliedfrakturen nach perkutaner, antegrader K-Draht-Osteosynthese. Patienten und Methoden Von insgesamt 90 Patienten, die zwischen 2010 und 2017 aufgrund einer isolierten Fingergrundgliedfraktur nach geschlossener Reposition mittels perkutaner, antegrader K-Draht-Osteosynthese operativ versorgt wurden, konnten 46 (17 Frauen und 29 Männer mit einem mittleren Alter von 42,8 Jahren) im Mittel nach 18,5 Monaten nachuntersucht werden. Bei 28 Patienten war eine frühfunktionelle, bei 18 eine statische Nachbehandlung erfolgt. Beide Gruppen unterschieden sich nicht statistisch signifikant bzgl. des Alters, der Geschlechtsverteilung, der Frakturlokalisation und -morphologie, des Unfallmechanismus und der Dauer der Operation. Bei der Nachuntersuchung wurde die aktive und passive Beweglichkeit des operierten Fingers (total active motion [TAM] und total passive motion [TPM], Fingerkuppen-Hohlhand-Abstand [FKHA], Nagelrand-verlängerter-Handrückenebenen-Abstand [NHREA]) und des korrespondierenden, unverletzten Fingers der Gegenseite gemessen und in Relation zueinander gesetzt (TAMrel, TPMrel). Des Weiteren wurde die Kraft bei verschiedenen Griffformen bestimmt und in Relation zur Kraft der unverletzten Gegenseite gesetzt. Intra- und postoperative Komplikationen, der DASH-Score und die Zeit bis zur Wiederaufnahme der Arbeitstätigkeit wurden erfasst. Ergebnisse Keine signifikanten Unterschiede zwischen den beiden Gruppen konnten bzgl. der Häufigkeit von Komplikationen und notwendiger Revisionen, der Fingerbeweglichkeit und Kraft festgestellt werden. Patienten mit aktiver Nachbehandlung kehrten im Vergleich zu Patienten mit statischer Nachbehandlung jedoch signifikant früher an ihre Arbeitsplätze zurück (2,5 vs. 9,0 Wochen nach operativer Versorgung, p = 0,035). Der DASH-Score in der Gruppe mit aktiver Nachbehandlung war mit 1,7 Punkten etwas niedriger als in der Gruppe mit statischer Nachbehandlung mit 2,5 Punkten (p = 0,269). Schlussfolgerung Patienten mit frühfunktioneller Nachbehandlung waren signifikant kürzer arbeitsunfähig. Zum Nachuntersuchungszeitpunkt fand sich kein Unterschied in der globalen Fingerbeweglichkeit beider Gruppen. Bei gegebener Compliance kann auf eine postoperative Ruhigstellung verzichtet werden.

Flexor Subzone II A–D Range of Motion Progression during Healing on a No-Splint, No-Tenodesis Protection, Immediate Full Composite Extension Regimen

2019 ◽  
Vol 24 (04) ◽  
pp. 405-411
Author(s):  
Mark Henry ◽  
Forrest H. Lundy
Keyword(s):  
Flexor Tendon ◽  
Dash Score ◽  
Active Motion ◽  
Rehabilitation Protocol ◽  
Single Finger ◽  
Total Active Motion ◽  
Joint Flexion ◽  
Zone Ii ◽  
Therapy Protocol ◽  
High Range

Background: The objective was to study the hypotheses that an advanced zone II flexor tendon rehabilitation protocol would avoid rupture, achieve a high range of excursion, and minimize interphalangeal contracture during both the early phases and at the conclusion of healing. We also proposed the null hypothesis of no difference between any two of the zone II subdivisions. Methods: Fifty-one consecutive adult patients with zone II flexor tendon repairs of a single finger were retrospectively evaluated on an active contraction rehabilitation protocol with no splint, no tenodesis protection, and immediate full composite extension. There were 38 males and 13 females with a mean age of 39 years (range 18–69) involving 15 index, 7 long, 6 ring, and 23 small fingers. Repairs were located in flexor subzone IIA for 8 fingers; subzone IIB, 14; subzone IIC, 19; and subzone IID, 10. Differences in outcome between any two subzones were compared by T-test with p < 0.05. Results: Mean active arcs of motion in degrees at 3 weeks post repair were PIP 1-93; DIP 0-44; and total active motion (TAM) 221. At 6 weeks PIP 2–98; DIP 1–51; and TAM 236. At 10–12 weeks PIP 1–101; DIP 1–56; and TAM 246. Final TAM by flexor subzone IIA was 243; IIB, 251; IIC, 246; and IID, 246. There were no significant differences between any two subzones. Mean final DASH score was 5. There were no ruptures. Conclusions: The results support the hypotheses. Outcomes of the therapy protocol demonstrated the lack of interphalangeal joint flexion contractures, high range of total active motion achieved early and sustained, and no ruptures. No differences were identified between and two of the flexor subzones.

Occupational and non occupational metacarpal bone fractures at the Mansoura University Emergency Hospital: A comparative study

2019 ◽  
Vol 35 (3) ◽  
pp. 248-255
Author(s):  
Samah Saleh El-Hadidy ◽  
Abdel-Hady El-Gilany ◽  
Khalid Nour ◽  
Enas Elsherbeny ◽  
Abdel Hamied Abdel Hamied
Keyword(s):  
Comparative Study ◽  
Bone Fractures ◽  
Handgrip Strength ◽  
Hand Function ◽  
Metacarpal Bone ◽  
Dash Score ◽  
Labour Law ◽  
Cross Sectional ◽  
Emergency Hospital ◽  
Metacarpal Fractures

Introduction Metacarpal fractures of the hand occur in active and working population. Objective The objective of this article is to compare between occupational and non occupational metacarpal fractures. Methods This is a cross-sectional comparative study with prospective components among patients with metacarpal fractures admitted to the Mansoura University Emergency Hospital in a 6-month period. Data were collected using a questionnaire that included personal and occupational histories and accident analysis. Clinical and radiological assessment of healing was done by DASH score and handgrip strength. Disability was estimated according to the Egyptian Labour Law. Results Of 149 patients, 56.4% and 43.6% were occupational and non occupational metacarpal fractures, respectively. The independent predictors of occupational metacarpal fracture are less than secondary education (adjusted odds ratio (AOR) = 4.2 (2–8.4)), being married (AOR = 4.2 (2.1–8.5)), and being a male (AOR = 7 (2.5–20)). Conclusions Lower education, being married, and being a male are risk factors of occupational metacarpal fractures. Surgery showed better hand function than conservative management.

scholarly journals Functional reconstruction of severe hand injuries using allogeneic tendons: a retrospective study

2020 ◽  
Vol 48 (10) ◽  
pp. 030006052095503
Author(s):  
Gu Heng Wang ◽  
Tian Mao ◽  
Shu Guo Xing ◽  
Ya Lan Chen ◽  
Yu Xuan Zhang ◽  
...  
Keyword(s):  
Cell Count ◽  
Grip Strength ◽  
Hand Function ◽  
Hand Injuries ◽  
Pinch Strength ◽  
Dash Score ◽  
Active Motion ◽  
Functional Reconstruction ◽  
Total Active Motion

Objective To evaluate the effectiveness and safety of allogeneic tendons for functional reconstruction of severe hand injuries. Methods From August 2007 to July 2014, we performed functional reconstruction with tendon allografts for severe hand injuries affecting two or more tendons. At the final follow-up, we assessed total active motion (TAM); pincer pinch strength; grip strength; Disabilities of the Arm, Shoulder, and Hand (DASH) score; degree of satisfaction; and adhesion. We measured the white blood cell count, C-reactive protein concentration, erythrocyte sedimentation rate, total T-cell count, and CD4+T/CD8+T ratio to evaluate the immune response and check for infection. Results Ten patients received 26 allogeneic tendons to reconstruct hand function. The average follow-up period was 50.0 months (range, 24–82 months). The TAM was 126.4° (12°–253°), pincer pinch strength was 0.83 kg (0–4.5 kg), and grip strength was 13.69 kg (4–41.5 kg). The DASH score was 14.25 (3.3–30.8), and seven and three patients were satisfied and partially satisfied, respectively. One patient developed tendon adhesion. All immune and infectious parameters were within the reference range. Conclusion Functional reconstruction using allogeneic tendons for severe hand injuries with multiple tendon defects was effective and safe; however, more research is needed.

Einfluss des Beginns auf das Ergebnis einer spezialisierten Handrehabilitation bei beruflichen Handverletzungen

2021 ◽  
Vol 53 (01) ◽  
pp. 61-66
Author(s):  
Michael Millrose ◽  
Simon Kim ◽  
Frank Eichenauer ◽  
Markus Gesslein ◽  
Andreas Eisenschenk ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Range Of Motion ◽  
Dash Score ◽  
Active Motion ◽  
Total Active Motion

Zusammenfassung Ziel Ziel der Studie war die Auswertung der Ergebnisse einer spezialisierten interdisziplinären Handrehabilitation in Abhängigkeit vom zeitlichen Abstand zwischen der Verletzung und dem Beginn der Rehabilitation. Patienten und Methoden Mit Hilfe von punktebasierten Fragebögen (Disability of the Arm, Shoulder and Hand Score [DASH-Score], European Quality of Life 5 Dimensions [EQ-5D]) und objektiven Messparametern (TAM = Total Active Motion bei Fingerverletzungen, ROM = Range of Motion bei Handgelenksverletzungen, Grobkraft) wurden die Ergebnisse von 76 Patienten mit Verletzungen von Fingern und Handgelenken oder einem komplexen regionalen Schmerzsyndrom (CRPS) zu Beginn, am Ende und bei der Nachuntersuchung 12–16 Wochen nach Ende der semistationären Rehabilitation analysiert. Die Patienten wurden in Gruppen mit einem frühen (< 120 Tage nach Trauma) bzw. späten Beginn der Rehabilitation aufgeteilt. Ergebnisse Patienten mit frühem Beginn der Rehabilitation hatten bei der Nachuntersuchung signifikant bessere Ergebnisse beim DASH-Score als auch beim Bewegungsausmaß des Handgelenkes. Auch waren signifikant mehr Patienten mit frühem Rehabilitationsbeginn zum Ende der Rehabilitation als auch bei der Nachuntersuchung arbeitsfähig als Patienten mit spätem Beginn der Rehabilitation. Insbesondere Patienten mit Fingerverletzungen und CRPS profitierten von einem frühen Beginn der Rehabilitation. Schlussfolgerung Ein früher Beginn der Rehabilitation nach Finger- und Handverletzungen sowie bei einem CRPS führt zu funktionell besseren Ergebnissen, wobei vor allem Patienten mit CRPS von einem frühen Beginn profitieren.

Immediate Corticocancellous Bone Autografting in Segmental Bone Defects of the Hand

2006 ◽  
Vol 31 (2) ◽  
pp. 168-177 ◽  
Author(s):  
MICHEL SAINT-CYR ◽  
DIEGO MIRANDA ◽  
RUBEN GONZALEZ ◽  
AMIT GUPTA
Keyword(s):  
Bone Grafting ◽  
Soft Tissue Injuries ◽  
Bony Union ◽  
Active Motion ◽  
Total Active Motion ◽  
The Mean ◽  
Segmental Bone ◽  
Corticocancellous Bone Grafting ◽  
Regular Work ◽  
Mean Time

We performed a retrospective analysis of 12 type III open hand fractures in seven patients with segmental bone loss and associated soft tissue injuries to determine the effectiveness of immediate autologous corticocancellous bone grafting. Radical débridement and fracture fixation were performed prior to bone grafting. Results were interpreted according to clinical and radiologic time of bony healing, rate of infection, time to return to regular work duty, grip strength, rate of complications and range of motion. The final union rate was 92%, with a mean time to bony union of 18 weeks. The infection rate was 0%. The mean time to return to regular work duty, including recovery time after secondary surgeries, was 5 months and 21 days. All patients returned to their pre-injury employment. The mean total active motion of the combined metacarpophalangeal proximal interphalangeal and distal interphalangeal joints in bone-grafted digits was 178±53° at final follow-up.

scholarly journals Evaluation of functional outcome of metacarpal fractures managed by operative techniques: a hospital based study

2021 ◽  
Author(s):  
Amit Kumar ◽  
Sanjeev Gupta ◽  
Vinay Badyal
Keyword(s):  
Functional Outcome ◽  
Traffic Accidents ◽  
Functional Disability ◽  
Road Traffic ◽  
Active Movement ◽  
Bony Union ◽  
Road Traffic Accidents ◽  
Operative Techniques ◽  
Metacarpal Fractures ◽  
K Wires

Background: Metacarpal fractures comprise approximately 35.5% of cases in daily emergencies, mostly due to road traffic accidents, fall, and assault. The main goal of treatment is to achieve the strong bony union without any functional disability. Aim of the study was evaluation of functional outcome of metacarpal fractures managed by operative techniques and to compare the efficacy of different operative techniques.Methods: A total of 50 patients managed by various operative techniques by using k-wires, screws and plates. Functional outcome was assessed by using total active movement (TAM) and disabilities of the arm, shoulder and hand (DASH) scoring system at 6th week, 3rd month and at 6th month.Results: A total 47 fractures united and three fractures mal-united at the time of final assessment. Overall excellent and good results were achieved in 94% cases.Conclusions: Our finding suggests that open reduction and internal fixation with k-wire is most preferable method among all other operative techniques.

The Triad of Multiple Metacarpal Fractures and/or Dislocations of the Fingers, Severe Hand Swelling and Clinical Evidence of Acute Median Nerve Dysfunction

2008 ◽  
Vol 33 (3) ◽  
pp. 298-304 ◽  
Author(s):  
M. M. AL-QATTAN
Keyword(s):  
Median Nerve ◽  
Clinical Evidence ◽  
Carpal Tunnel Release ◽  
Fracture Site ◽  
Active Motion ◽  
Metacarpal Fractures ◽  
Joint Fracture ◽  
Total Active Motion ◽  
Nerve Dysfunction ◽  
Open Carpal Tunnel Release

Twenty-five cases of crush injury to the hand resulting in the triad of multiple finger metacarpal fractures/dislocations of the fingers, a balloon hand appearance due to severe swelling and clinical evidence of acute median nerve dysfunction were retrospectively reviewed. All were men with a mean age of 33 (range 20–45) years. All injuries occurred following industrial or major car accidents. The fracture site included metacarpal head/neck fractures, metacarpal shaft fractures and carpometacarpal joint fracture–dislocations. All patients underwent fasciotomies, open carpal tunnel release and fixation of displaced fractures, followed by immediate mobilisation of the fingers. At a mean final follow-up of 7 (range 6–8) months, full recovery of median nerve function was seen in all patients. The final mean total active motion of the fingers was 243°, 230° and 250° in displaced distal, middle and proximal impact fractures, respectively. All patients were able to return back to work.

scholarly journals Functional Outcome Following Hand and Wrist Level Replantation: A Retrospective Review

2020 ◽  
pp. 1-5
Author(s):  
Rahul K. Patil ◽  
Rahul K. Patil ◽  
Venkata Nageshwara Reddy Komma ◽  
Emad Salah Ibrahim ◽  
Abdullah Al Harthi ◽  
...  
Keyword(s):  
Functional Outcome ◽  
Primary Repair ◽  
Distal Forearm ◽  
Level Of Evidence ◽  
Active Motion ◽  
Early Motion ◽  
Sensory Recovery ◽  
Total Active Motion ◽  
Industrial Injuries

Objective: Amputations of fingers and significant parts of upper limbs are common following industrial injuries. This study was aimed at assessing the functional outcome in patients with hand replantation following amputation at the level of distal forearm or wrist. Methods: Patients presenting with amputation at the level of wrist and forearm between Jan 2015 and December 1018, with adequate follow up were included. The function in terms of total active motion at the fingers and wrist, sensory recovery, and patient satisfaction and DASH scores at the final follow up were noted. Results: Four cases of replantation at the level of wrist and one replantation at distal forearm level were included in the study. A total of 3 patients were excluded for various reasons. The average follow-up period was 38 months. The average total active motion of fingers achieved was 212○ . All patients recovered protective sensations. Conclusion: Replantation of amputated major upper limb parts restores useful function and should be attempted. Minimizing ischaemia time, secure fixation, primary repair of structures and early motion are determinants of reasonable functional outcome. Level of evidence: IV.

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