Objective: To evaluate the effectiveness of the modified intramedullary fixation with two Kirschner wires for extra-articular fracture of the proximal phalangeal base.
Methods: Between June 2012 and November 2015, 18 cases (18 fingers) of fresh extra-articular fracture of the proximal phalangeal base were treated, including 16 males and 2 females with an average age of 31 years (range, 21-57 years). The causes included strike injury in 10 cases, fall injury in 4 cases, mechanical injury in 1 case, twist injury in 1 case, crush injury in 1 case, and cutting injury in 1 case. The injured fingers were little finger in 16 cases, ring finger in 1 case, and index finger in 1 case. Of the 18 cases, 17 had closed fractures and 1 had open fracture. X-ray film showed transverse fracture in 14 cases and transverse-oblique fracture in 4 cases. The time between injury and operation was 3 hours to 4 days (mean, 2 days). After anatomical reduction, two Kirschner wires were used for intramedullary fixation. Functional exercises were done at 2 days after operation. The Kirschner wires were removed at 4 weeks after operation.
Results: All the wounds healed by first intention. There were no deformation, loosening or breakage of Kirschner wires, and pin tract infection. Postoperative X-ray films showed anatomical reduction of fracture in all cases; no re-displacement happened, and clinical healing was obtained at 4 weeks; bony union was obtained at 8 weeks. All patients were followed up 6-12 months with an average of 8 months. There was no pain in the metacarpophalangeal joint; the range of motion was (88.1±2.3)° at 3 months after operation, showing no significant difference when compared with normal side [(88.8±2.6)°] (t=1.73, P=0.10). The finger flexion and extension were normal; according to the criteria of total active motion of finger, the results were excellent in all cases.
Conclusions: The technique of modified intramedullary fixation with two Kirschner wires for extra-articular fractures of the proximal phalangeal base has the merits of convenient operation, little injury, reliable fixation,and excellent effectiveness. This technique is conducive to the recovery of hand function due to the early functional exercises.
目的: 探讨改良双克氏针髓内固定法治疗近节指骨基底部关节外骨折的疗效。.
方法: 2012年6月-2015年11月，收治18例（18指）近节指骨基底部关节外骨折患者。男16例，女2例；年龄21～57岁，平均31岁。致伤原因：击打伤10例，摔伤4例，机器绞伤1例，暴力扭伤1例，挤压伤1例，切割伤1例。损伤指别：小指16例，环指1例，示指1例。均为新鲜骨折；伤后至手术时间为3 h～4 d，平均2 d。闭合骨折17例，开放骨折1例。X线片检查示，横形骨折14例，横斜形骨折4例。骨折复位后，采用改良双克氏针髓内固定，不固定掌指关节。术后2 d开始功能锻炼，4周后拔除克氏针。.
结果: 术后切口均Ⅰ期愈合，无针道感染以及克氏针变形、松动或断裂发生。X线片复查示，骨折均解剖复位；4周时骨折无移位，均达临床愈合；8周达骨性愈合。患者均获随访，随访时间6～12个月，平均8个月。掌指关节活动无疼痛，术后3个月活动范围为（88.1±2.3）°，与健侧（88.8±2.6）°比较，差异无统计学意义（t=1.73，P=0.10）。患指屈伸活动正常，按照手指总主动活动度（total active motion，TAM）评价标准均达优。.
结论: 采用改良双克氏针髓内固定法治疗近节指骨基底部关节外骨折，能早期活动掌指关节，有利于手功能恢复，具有操作简便、固定可靠、损伤小、疗效肯定的优点。.
Keywords: Basal fracture; Intramedullary fixation; Kirschner wire; Phalanx.