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

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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. 钩骨-掌骨关节骨折背侧脱位患者的跨关节桥接钢板内固定治疗. 中国骨与关节杂志, 2017, 6(4): 252-257.
3.	王天兵, 姜保国, 傅中国, 等. AO 微型纯钛板钉内固定治疗掌指骨关节内骨折. 中华手外科杂志, 2004, 20(2): 90-91.
4.	吴中桓, 孙广峰, 金文虎, 等. 第五掌骨基底部骨折治疗进展. 中华临床医师杂志 (电子版), 2015, 9(10): 177-181.
5.	胡宏宇, 高顺红, 于志亮, 等. 第 5 掌骨基底骨折脱位的特点及治疗方法的选择. 中国骨与关节损伤杂志, 2015, 30(5): 544-545.
6.	郜永斌, 田光磊. 钩骨-掌骨关节骨折背侧脱位. 实用手外科杂志, 2004, 18(4): 225-227.
7.	赵春鹏, 路来金, 刘志刚, 等. 带血管蒂第 5 腕掌关节移位的应用解剖学. 中国临床解剖学杂志, 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.	陈振兵, 洪光祥, 王发斌. 钩骨钩部骨折四例报告及文献复习. 中华手外科杂志, 2004, 20(1): 3-4.
10.	赵民, 田德虎, 邵新中, 等. 第五掌骨基底部骨折伴腕掌关节脱位的诊断及治疗. 中国修复重建外科杂志, 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.	张文龙, 王玉峰, 王良, 等. 闭合复位克氏针横向固定治疗第 5 掌骨基底骨折. 中华骨科杂志, 2013, 33(7): 714-718.
14.	何晓清, 徐永清, 朱跃良, 等. 第 4、5 腕掌关节骨折脱位 6 例. 中华手外科杂志, 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.	刘坤, 田文, 杨勇, 等. 闭合或有限切开复位微型外固定架联合克氏针固定治疗闭合性第 5 掌骨底骨折或脱位. 骨科临床与研究杂志, 2017, 2(5): 273-278.
17.	杨焕友, 李瑞国, 刘娜, 等. 微型钉板治疗第五掌骨基底骨折伴掌腕关节脱位疗效观察. 中国骨与关节损伤杂志, 2012, 27(5): 464-465.
18.	李永福. 内固定治疗第 5 掌骨基底部粉碎性骨折. 临床骨科杂志, 2015, 18(5): 559, 560.

1. 孙涛, 王海立, 朱燕宾, 等. 2003 年至 2012 年河北医科大学第三医院成人掌骨骨折的流行病学研究. 中华创伤骨科杂志, 2014, 16(7): 603-606.
2. 李忠哲, 郜永斌, 田光磊. 钩骨-掌骨关节骨折背侧脱位患者的跨关节桥接钢板内固定治疗. 中国骨与关节杂志, 2017, 6(4): 252-257.
3. 王天兵, 姜保国, 傅中国, 等. AO 微型纯钛板钉内固定治疗掌指骨关节内骨折. 中华手外科杂志, 2004, 20(2): 90-91.
4. 吴中桓, 孙广峰, 金文虎, 等. 第五掌骨基底部骨折治疗进展. 中华临床医师杂志 (电子版), 2015, 9(10): 177-181.
5. 胡宏宇, 高顺红, 于志亮, 等. 第 5 掌骨基底骨折脱位的特点及治疗方法的选择. 中国骨与关节损伤杂志, 2015, 30(5): 544-545.
6. 郜永斌, 田光磊. 钩骨-掌骨关节骨折背侧脱位. 实用手外科杂志, 2004, 18(4): 225-227.
7. 赵春鹏, 路来金, 刘志刚, 等. 带血管蒂第 5 腕掌关节移位的应用解剖学. 中国临床解剖学杂志, 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. 陈振兵, 洪光祥, 王发斌. 钩骨钩部骨折四例报告及文献复习. 中华手外科杂志, 2004, 20(1): 3-4.
10. 赵民, 田德虎, 邵新中, 等. 第五掌骨基底部骨折伴腕掌关节脱位的诊断及治疗. 中国修复重建外科杂志, 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. 张文龙, 王玉峰, 王良, 等. 闭合复位克氏针横向固定治疗第 5 掌骨基底骨折. 中华骨科杂志, 2013, 33(7): 714-718.
14. 何晓清, 徐永清, 朱跃良, 等. 第 4、5 腕掌关节骨折脱位 6 例. 中华手外科杂志, 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. 刘坤, 田文, 杨勇, 等. 闭合或有限切开复位微型外固定架联合克氏针固定治疗闭合性第 5 掌骨底骨折或脱位. 骨科临床与研究杂志, 2017, 2(5): 273-278.
17. 杨焕友, 李瑞国, 刘娜, 等. 微型钉板治疗第五掌骨基底骨折伴掌腕关节脱位疗效观察. 中国骨与关节损伤杂志, 2012, 27(5): 464-465.
18. 李永福. 内固定治疗第 5 掌骨基底部粉碎性骨折. 临床骨科杂志, 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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