Effectiveness analysis of maintaining the stability between the fourth and the fifth metacarple base during the treatment in the hamate-metacarpal joint injury_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

LIU Anxiong , SUN Haoran ,  JIANG Zongyuan , OUYANG Yanggang , CHEN Qi , XIE Tongming , LIANG Hai

Department of Hand Surgery, People’s Hospital of Longhua, Shenzhen Guangdong, 518109, P.R.China;

Corresponding?author：

JIANG Zongyuan, Email: jiangzongyuan@medmail.com.cn

Keywords：

The fourth and fifth metacarple base; hamate-metacarpal joint; classification; across-joint internal fixation

DOI：

10.7507/1002-1892.201711006

Video：

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Objective To explore the effectiveness of maintaining the stability between the fourth and the fifth metacarple base during the treatment in the hamate-metacarpal joint injury. Methods Between September 2015 and June 2017, 13 cases of hamate-metacarpal joint injury were treated, including 12 males and 1 female, aged from 17 to 55 years (mean, 30.8 years). The injury causes included heavy boxing in 10 cases and falling in 3 cases. There were 2 cases of simple fourth metacarpal basal fracture, 1 basal fracture of the fourth metacarpal bone combined with intermetacarpal ligament fracture, 7 fractures of the fourth and fifth metacarpal base, 2 fourth metacarpal basal fractures combined with the fifth metacarpal basal fracture dislocation, and 1 base fracture of fourth and fifth metacarpal bone combined with hamate bone fracture. The time from injury to operation was 5-11 days (mean, 7.2 days). According to different damage degree and stability change between the fourth and the fifth metacarple base, a preliminary classification was made for different degrees of injury: 2 cases of type Ⅰ, 1 case of type Ⅱ, 7 cases of type Ⅲ, 2 cases of type Ⅳ, and 1 case of type Ⅴ. The patients were treated with corresponding internal fixation methods under the principle of stability recovery between the fourth and fifth metacarple base. Results All the incisions healed by first intention without infection or skin necrosis. All the 13 patients were followed up 6-18 months with an average of 9.4 months. All fractures healed clinically, and the healing time was 5.5-8.0 weeks with an average of 6.3 weeks. No complication such as plate breakage, fracture dislocation, fracture malunion, and bone nonunion occurred. Hand function was evaluated according to the total active motion (TAM) functional evaluation standard of hand surgery at 6 months after operation, and the results was excellent in 9 cases, good in 3 cases, and fair in 1 case, with an excellent and good rate of 92.3%. Conclusion Stability between the fourth and fifth metacarple base is of great significance to the classification and the treatment of the hamate-metacarpal joint injury.

Citation： LIU Anxiong, SUN Haoran, JIANG Zongyuan, OUYANG Yanggang, CHEN Qi, XIE Tongming, LIANG Hai. Effectiveness analysis of maintaining the stability between the fourth and the fifth metacarple base during the treatment in the hamate-metacarpal joint injury. Chinese Journal of Reparative and Reconstructive Surgery, 2018, 32(8): 984-988. doi: 10.7507/1002-1892.201711006 Copy

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2.	李忠哲, 郜永斌, 田光磊. 鉤骨-掌骨關節骨折背側脫位患者的跨關節橋接鋼板內固定治療. 中國骨與關節雜志, 2017, 6(4): 252-257.
3.	王天兵, 姜保國, 傅中國, 等. AO 微型純鈦板釘內固定治療掌指骨關節內骨折. 中華手外科雜志, 2004, 20(2): 90-91.
4.	吳中桓, 孫廣峰, 金文虎, 等. 第五掌骨基底部骨折治療進展. 中華臨床醫師雜志 (電子版), 2015, 9(10): 177-181.
5.	胡宏宇, 高順紅, 于志亮, 等. 第 5 掌骨基底骨折脫位的特點及治療方法的選擇. 中國骨與關節損傷雜志, 2015, 30(5): 544-545.
6.	郜永斌, 田光磊. 鉤骨-掌骨關節骨折背側脫位. 實用手外科雜志, 2004, 18(4): 225-227.
7.	趙春鵬, 路來金, 劉志剛, 等. 帶血管蒂第 5 腕掌關節移位的應用解剖學. 中國臨床解剖學雜志, 2002, 30(1): 48-50.
8.	El-Shennawy M, Nakamura K, Patterson RM, et al. Three-dimensional kinematic analysis of the second through fifth carpometacarpal joints. J Hand Surg (Am), 2001, 26(6): 1030-1035.
9.	陳振兵, 洪光祥, 王發斌. 鉤骨鉤部骨折四例報告及文獻復習. 中華手外科雜志, 2004, 20(1): 3-4.
10.	趙民, 田德虎, 邵新中, 等. 第五掌骨基底部骨折伴腕掌關節脫位的診斷及治療. 中國修復重建外科雜志, 2013, 27(6): 662-665.
11.	Cain JE Jr, Shepler TR, Wilson MR. Hamatometacarpal fracture-dislocation: classification and treatment. J Hand Surg (Am), 1987, 12(5 Pt 1): 762-767.
12.	Bushnell BD, Draeger RW, Crosby CG, et al. Management of intra-articular metacarpal base fractures of the second through fifth metacarpals. J Hand Surg (Am), 2008, 33(4): 573-583.
13.	張文龍, 王玉峰, 王良, 等. 閉合復位克氏針橫向固定治療第 5 掌骨基底骨折. 中華骨科雜志, 2013, 33(7): 714-718.
14.	何曉清, 徐永清, 朱躍良, 等. 第 4、5 腕掌關節骨折脫位 6 例. 中華手外科雜志, 2014, 30(1): 64-66.
15.	Dubert TP, Khalifa H. " Stabilized arthroplasty” for old fracture dislocations of the fifth carpometacarpal joint. Tech Hand Up Extrem Surg, 2009, 13(3): 134-136.
16.	劉坤, 田文, 楊勇, 等. 閉合或有限切開復位微型外固定架聯合克氏針固定治療閉合性第 5 掌骨底骨折或脫位. 骨科臨床與研究雜志, 2017, 2(5): 273-278.
17.	楊煥友, 李瑞國, 劉娜, 等. 微型釘板治療第五掌骨基底骨折伴掌腕關節脫位療效觀察. 中國骨與關節損傷雜志, 2012, 27(5): 464-465.
18.	李永福. 內固定治療第 5 掌骨基底部粉碎性骨折. 臨床骨科雜志, 2015, 18(5): 559, 560.

1. 孫濤, 王海立, 朱燕賓, 等. 2003 年至 2012 年河北醫科大學第三醫院成人掌骨骨折的流行病學研究. 中華創傷骨科雜志, 2014, 16(7): 603-606.
2. 李忠哲, 郜永斌, 田光磊. 鉤骨-掌骨關節骨折背側脫位患者的跨關節橋接鋼板內固定治療. 中國骨與關節雜志, 2017, 6(4): 252-257.
3. 王天兵, 姜保國, 傅中國, 等. AO 微型純鈦板釘內固定治療掌指骨關節內骨折. 中華手外科雜志, 2004, 20(2): 90-91.
4. 吳中桓, 孫廣峰, 金文虎, 等. 第五掌骨基底部骨折治療進展. 中華臨床醫師雜志 (電子版), 2015, 9(10): 177-181.
5. 胡宏宇, 高順紅, 于志亮, 等. 第 5 掌骨基底骨折脫位的特點及治療方法的選擇. 中國骨與關節損傷雜志, 2015, 30(5): 544-545.
6. 郜永斌, 田光磊. 鉤骨-掌骨關節骨折背側脫位. 實用手外科雜志, 2004, 18(4): 225-227.
7. 趙春鵬, 路來金, 劉志剛, 等. 帶血管蒂第 5 腕掌關節移位的應用解剖學. 中國臨床解剖學雜志, 2002, 30(1): 48-50.
8. El-Shennawy M, Nakamura K, Patterson RM, et al. Three-dimensional kinematic analysis of the second through fifth carpometacarpal joints. J Hand Surg (Am), 2001, 26(6): 1030-1035.
9. 陳振兵, 洪光祥, 王發斌. 鉤骨鉤部骨折四例報告及文獻復習. 中華手外科雜志, 2004, 20(1): 3-4.
10. 趙民, 田德虎, 邵新中, 等. 第五掌骨基底部骨折伴腕掌關節脫位的診斷及治療. 中國修復重建外科雜志, 2013, 27(6): 662-665.
11. Cain JE Jr, Shepler TR, Wilson MR. Hamatometacarpal fracture-dislocation: classification and treatment. J Hand Surg (Am), 1987, 12(5 Pt 1): 762-767.
12. Bushnell BD, Draeger RW, Crosby CG, et al. Management of intra-articular metacarpal base fractures of the second through fifth metacarpals. J Hand Surg (Am), 2008, 33(4): 573-583.
13. 張文龍, 王玉峰, 王良, 等. 閉合復位克氏針橫向固定治療第 5 掌骨基底骨折. 中華骨科雜志, 2013, 33(7): 714-718.
14. 何曉清, 徐永清, 朱躍良, 等. 第 4、5 腕掌關節骨折脫位 6 例. 中華手外科雜志, 2014, 30(1): 64-66.
15. Dubert TP, Khalifa H. " Stabilized arthroplasty” for old fracture dislocations of the fifth carpometacarpal joint. Tech Hand Up Extrem Surg, 2009, 13(3): 134-136.
16. 劉坤, 田文, 楊勇, 等. 閉合或有限切開復位微型外固定架聯合克氏針固定治療閉合性第 5 掌骨底骨折或脫位. 骨科臨床與研究雜志, 2017, 2(5): 273-278.
17. 楊煥友, 李瑞國, 劉娜, 等. 微型釘板治療第五掌骨基底骨折伴掌腕關節脫位療效觀察. 中國骨與關節損傷雜志, 2012, 27(5): 464-465.
18. 李永福. 內固定治療第 5 掌骨基底部粉碎性骨折. 臨床骨科雜志, 2015, 18(5): 559, 560.

Chinese Journal of Reparative and Reconstructive Surgery

Effectiveness analysis of maintaining the stability between the fourth and the fifth metacarple base during the treatment in the hamate-metacarpal joint injury

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