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DYNAMIC EXTERNAL FIXATION FOR COMMINUTED INTRA‐ARTICULAR METACARPAL HEAD FRACTURE OF THE THUMB
Author(s) -
Dhillon R. S.,
Baldwin R.,
Alkadhi A.,
Moaveni Z.
Publication year - 2009
Publication title -
anz journal of surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.426
H-Index - 70
eISSN - 1445-2197
pISSN - 1445-1433
DOI - 10.1111/j.1445-2197.2009.04918_10.x
Subject(s) - medicine , thumb , range of motion , internal fixation , reduction (mathematics) , surgery , fixation (population genetics) , malunion , rehabilitation , metacarpophalangeal joint , orthodontics , nonunion , physical therapy , population , geometry , mathematics , environmental health
Principles of osteosynthesis for intra‐articular fractures dictate anatomic reduction of the fracture fragments to restore articular surface congruity and to allow early active joint motion. Open reduction and internal fixation of small comminuted intraarticular fragments may not be possible and risk devitalizing blood supply to the small fragments. Suzuki et al. described the Pins and Rubber band Traction System (PRTS) for proximal interphalyngeal joint pilon fractures. This method relies on capsuloligamentotaxis to reduce the fracture. We describe the successful use of this device for a severely comminuted fracture of the thumb metacarpal head. A 52 year old right hand dominant office manager sustained a mechanical fall with an axial compression force onto the right thumb and sustained a closed comminuted intraarticular fracture of the metacarpal head. Given the degree of comminution seen on CT, we elected to treat this with the PRTS although it is for a different indication than that described by Suzuki. We modified the post‐operative rehabilitation regime. The QuickDASH score was 20/100. The patient had achieved full range of motion (equal to the uninjured side) and full return of function by the 6 week follow up. Six month follow‐up revealed an excellent outcome and repeat radiograph showed preservation of joint space and remodelling of the metacarpal head. This paper discussed the operative and rehabilitation details of this case. We feel that in such cases minimally invasive treatment with dynamic external fixation allows early joint motion and excellent outcomes without inherent risks of open reduction and internal fixation of the small comminuted fragments.