HEALING OF ARTICULAR AND PERIARTICULAR METACARPAL AND PHALANGEAL FRACTURES
Abstract
Background. Primary treatment of 779 closed epiphysial, diaphyseal, comminutive, oblique and periarticular fractures of metacarpals and phalanges was carried out with painless reposition and fixation with a plaster splint. In 435 cases, fracture slides occurred after one week. For correction, the ligamentotaxis metod with aluminium (Alu-) splint and Softcast plaster was used. This method allows the retaining of a good position of fractured fragments after reposition by neutralization of the pathologic action of kinetic vectors on these fragments. Our goal in using this method is to stabilize the fractured fragments individually with consideration of soft tissues.
Methods. In local (in the fracture) or Oberst analgesia, a correct size Alu-splint is placed over the wad-protected skin on the volar or dorsal side of the hand. The Alu-splint is fixed with Urgopore proximally and distally from the fracture. Then, correction using the reduction technique over the Alu-splinting is done. Such correction is followed by X-ray control and if the fragments are in good position, the construction is fixed with plaster. One week later, X-ray control verifies the position of broken parts.
Results. In the year 2000, 740 outpatients with a total of 779 (100%) metacarpal and phalangeal fractures were treated. There were 569 (73%) men and 210 (27%) women. The incidence in men was highest in the 10–19 years age group with 143 fractures. In the 50–59 years group, the incidence was equal in men and women (69 fractures). The highest prevalence of fracture slides was in the group of proximal phalanx fractures (190 fractures or 44%). X-ray control after one week showed 435 (56%) fracture slides in immobilization with plaster. This high percentage is due to a severe damage to skeletal connective tissue. 321 (41%) fractures were re-repositioned with ligamentotaxis, 172 (22%) fracture slides were treated using other methods (e.g. surgery). 385 (49%) fractures treated with ligamentotaxis were without significant slides, the fragments healing in good position. End functional results were satisfactory. We had only one decubitus, which healed per primam after reshaping of the splint.
Conclusions. The application of local analgesia and ligamentotaxis represents a simple and safe method of treatment. It allows individual biomechanical neutralization of the pathologic activity of kinetic energy vectors on the fracture. Repositioning and physiological positioning of the hand in Softcast plaster is simple, there is no need to hospitalize the patient for surgery. This makes the method less costly as well. There are less fracture slides, and repairs due to decubitus are simpler as there is no need for total immobilization removal. Therefore ligamentotaxis is the method of choice.
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