Dorsal approach for isolated volar fracture-dislocation of the base of the second metacarpal:A case report

BACKGROUND We report a case with the displacement of an articular fracture fragment of the base of the second metacarpal from the ulnar to the volar side,treated via the dorsal approach.The dorsal approach can be a good option not only because it allows direct observation of ligament damage and fixation of bone fragments but also because the thin subcutaneous tissue makes the approach easier.CASE SUMMARY A 45-year-old man with a right hand injury visited the hospital.A small bone fragment was identified using plain radiography.Lateral radiography revealed the fragment as lying over the volar aspect of the carpometacarpal(CMC)joint.Computed tomography revealed that approximately one-third of the CMC joint surface of the second metacarpal was damaged.We provisionally diagnosed an intra-articular fracture with significant CMC joint instability and performed open reduction and internal fixation.We made a dorsal longitudinal incision over the CMC joint between the second and third metacarpals.The dorsal ligament of the third CMC joint was torn.We thought it had been dislocated to the volar side and spontaneously reduced to that position.There are only few reports of volar dislocation of CMC joint fractures,particularly of the second and third metacarpals;our report is unique as our patient had an intact interosseous ligament between the second and third metacarpals.CONCLUSION Although past reports have used a palmar approach,the dorsal approach is a good option for these cases.

Intracortical chondroma of the metacarpal bone:A case report

BACKGROUND Intracortical chondroma of the metacarpal bone which could be painful is an extremely rare condition and previously only one case has been reported.Due to the similar physical features and appearance on clinical imaging,it is difficult to differentiate between intracortical chondroma and osteoid osteoma.Therefore,pathological examination is usually required to establish a definite diagnosis,which is often carried out only after tumor removal.In this study,we describe a case of intracortical chondroma which developed in the metacarpal bone and demonstrate the utility of magnetic resonance imaging(MRI).CASE SUMMARY We present a case of a 40-year-old man with intracortical chondroma of the metacarpal bone who was strongly suspected of having a tumor,and it was confirmed using contrast-enhanced MRI and successfully treated with curettage.MRI performed before tumor removal revealed signal intensity similar to that of the nidus of an osteoid osteoma.However,no abnormal intensity was observed in the bone or soft tissues surrounding the tumor.Such abnormalities on images would indicate the presence of soft-tissue inflammation,which are characteristics of osteoid osteoma.Furthermore,contrast-enhanced imaging revealed no increased enhancement of the areas surrounding the tumor.This is the first report to describe the contrast-enhanced MRI features of intracortical chondroma.This may serve as a guide for clinicians when intracortical chondroma is suspected.CONCLUSION The contrast-enhanced MRI was useful for the differential diagnosis of intracortical chondroma.

The Effect of Fascial Pedicled Island Flap of the First Metacarpal Radial Dorsal Artery Skin Branch Chain on the Repair of Thumb Tissue Defect

Objective To analyze the effect of fascial pedicled island flap of the first metacarpal radial dorsal artery skin branch chain on the repair of thumb tissue defect.Methods take the 100 patients with thumb tissue defects treated in our hospital from 2017.01 to 2019.01 as the research objects,and divide them into control group and observation group randomly,50 cases in each group.In the observation group,the fascial pedicled island flap of the first metacarpal radial dorsal artery skin branch chain is used for repair,and in the control group,the thumb tissue is repaired with abdominal flap.Compare the DASH scores and outcomes of two groups.Results After treatment,the DASH score in the observation group is significantly lower than that in the control group,which is statistically significant(P<0.05);The operation time and intraoperative blood loss of Observation Group is significantly lower than Control Group,which is statistically significant(P<0.05).Conclusion Repairing defected thumb with the fascial pedicled island flap of the first metacarpal radial dorsal artery skin branch chaint has the advantages of simple operation and easy mastery,and has significant curative effect on patients.It is an effective way to repair partial thumb defect,and worth popularizing.

Surgical Fixation of Fourth and Fifth Metacarpal Shaft Fractures with Flexible Intramedullary Absorbable Rods： Early Clinical Outcomes and Implications

Background： To avoid the irritation of tendons and soft tissues as well as hardware-related problems, we designed an intramedullary fixation with bioabsorbable rods for the treatment of the metacarpal shaft fractures. Methods： Five patients with nine shaft fractures of the fourth and fifth metacarpi were treated with intramedullary absorbable implants and followed up with an average of 4.2 months postoperatively. Results： At final follow-up, all patients achieved fracture union with no signs of inflammatory or subcutaneous effusion. There was no shortening, angulatory, or rotatory deformity. There was almost full active extension range of motion （ROM） of the metacarpophalangeal joints while the active flexion ROM of these joints was 80.7 ± 9.6°. hand was 94.0 ± 9.6%. X-rays showed that the arch of the second Compared with the contralateral hand, the grip strength of the injured to fifth metacarpal heads was smooth. There were no intramedullary lytic changes and soft tissue swellings. Conclusion： The intramedullary absorbable implants are a safe, simple, and practical treatment for fourth and filth metacarpal fractures with good early clinical outcomes and no significant complications.

Clinical application of the second metacarpal bone lateral needling

Objective： To explore the rules of the second metacarpal bone lateral needling in clinical application and its characteristics so as to provide the guidance to clinical practice.Methods： Taking ＂the second metacarpal holographic acupuncture therapy＂ ＂the second metacarpal bone lateral needling＂ and ＂the second metacarpal bone＂ as the search terms, the papers on the second metacarpal bone lateral needling were retrieved from China National Knowledge Infrastructure（CNKI）and Wanfang database from January 1, 1974 to December 31, 2016 and were screened. Using the Excel2003, the database of the diseases treated by the second metacarpal bone lateral needling was set up.The indications, the acupoints selection rules and needling manipulation of this therapy were analyzed.Results： A total of 1103 papers were retrieved, of which, 446 papers were from CNKI and 657 from Wanfang database. According to the inclusion and exclusion criteria, 54 papers were included for analysis finally. It was found that the indications of the second metacarpal bone lateral needling were predominated by the soft tissue injuries, especially acute lumbar sprain, ankle sprain and knee joint injury. Regarding the acupoints selection rules of the second metacarpal bone lateral needling, the corresponding points and tender points were commonly selected. Regarding the needling manipulation, the strong stimulation was required after needle insertion and the patient was required to move the affected areas while keeping the strong needling sensation. The needles were inserted 20 mm in depth along the skin mainly.The even-needling technique was exerted and the needles were retained for 30 min mainly.Conclusion： The second metacarpal bone lateral needling is applied to the treatment of soft tissue injuries. It is applicable for some internal diseases. The strong needling sensation and the motion of the local affected area are required especially in treatment with this therapy.

Biomechanical Functions of the Canine Metacarpal and Metatarsal Pads during Locomotion:A Comparative Analysis

It is generally known that forelimbs and hindlimbs play different roles during locomotion,but the possible differences in the biomechanical functions of the metacarpal pad and metatarsal pad remain unknown.This study combined kinematic and pressure data from dogs to investigate the key roles of the metacarpal and metatarsal pads.The peak vertical ground reaction force of the metacarpal pad was found to be larger than that of the metatarsal pad,whereas the peak vertical ground reaction force of the fore toes was equal to that of hind toes,and the vertical defonnations of the metacarpal and metatarsal pads were almost equal;moreover,the obtained stiffness of the metacarpal pad was several times greater than that of metatarsal pad based on in vivo measurement data.The results showed that the metacarpal pad demonstrated the biomechanical characteristics of cushion and support;however,the support characteristics of the metatarsal pad were weak.Furthermore,magnetic resonance imaging was performed to gather evidence to interpret the various roles played by the metacarpal pad and the metatarsal pad.It was found that the morphology and volumes of internal adipose tissues were closely related to the functions played by the metapodial pad during movement.

Correlation between tibial nail length and olecrenon to 5th metacarpal head measurement: An anthropometric study

Purpose:During fracture fixation,the size of tibial nail is a vital factor affecting the outcomes and thus preoperative estimation of tibial nail length is very important.This study aims to find out whether"olecranon to 5th metacarpal head"(O-MH)measurement can be used to reliably predict the tibial nail length.Methods:This was a cross sectional study involving 100 volunteers.Measurements were done and recorded by two observers on two separate occasions.Tibial nail length estimation measurement was done from highest point of tibial tuberosity to the tip of the medial malleolus(TT-MM).O-MH measurement was taken from tip of olecranon to the tip of 5th metacarpal head with wrist in neutral position and hand clenched.Statistical analysis was done to find out correlation between two measurements and influence of age,gender and body mass index on them.Results:Paired t-test showed no systematic error between the readings.Intraclass correlation coefficient showed strong agreement in inter and intra observer settings.Strong correlation was found between the TT-MM&O-MH measurements using Pearson's correlation coefficient test(r=0.966).Hierarchical regression analysis showed age,gender and BMI have no statistically significant bearings on these measurements and their correlations.Conclusion:O-MH measurement is a useful and accurate means of estimating tibial nail length preoperatively.

Degree and location of metacarpal angulations

Aim: Fractures of metacarpals are commonly encountered in hand surgery. For adequate fixation, a thorough knowledge about the anatomy is essential. While fixing the metacarpals with plates and screws, plates are bent to contour the dorsal surface. However, there are no reference values in literature for the location and degree of angulation. The authors studied the dorsal surface of metacarpals in cadavers to gather data regarding the location and degree of angulation of the dorsal cortex. Methods: Cadaveric dissections of 118 metacarpals from 30 hands were performed. A true lateral view of each metacarpal was taken using fluoroscopy.These pictures were analyzed using Image J software. The dorsal cortex angle was measured in each image, and the center of rotation of angulation (CORA) was identified. The distance from the CORA to the base of metacarpal was measured and calculated as a percentage of the metacarpal length. Results: The average dorsal angle of the metacarpals was 11.5°. The average angles for each metacarpal were as follows: 2nd metacarpal = 13° (range, 6-26°;SD, 4.73), 3rd = 10° (range, 1-25°;SD, 5.28), 4th = 11° (range, 1-20°;SD, 4.45), 5th = 12°(range, 2-24°;SD, 5.11). The average location of the CORA from the base of the metacarpal as a percentage of the metacarpal length was identified as follows: 53.5% for the index finger,52.1% for the long finger, 48.3% for the ring finger and 50.3% for the small finger. Conclusion:These measurements are able to serve as reference values for plate bending while operating on a metacarpal fracture or metacarpal corrective osteotomy.

太原师范学院汉族大学生手长、掌长、指长和身高的关系

目的探讨太原师范学院在校汉族学生手长、掌长、指长和身高的关系。方法对463名在校汉族大学生的手长、掌长、指长和身高的抽查并进行统计学研究分析。结果显示太原师范学院汉族大学生的手长、掌长、指长和身高显著相关。结论所得的相关回归方程可用于推算汉族大学生的身高。

Traumatic Floating Bone. About 11 Cases and a Literature Review

Introduction: Floating bone injury or bipolar dislocation is a concurrent dislocation at both ends of a long bone or a flat bone. It is an exceptional injury. We report 11 consecutives cases of floating bones. Objectives: The aim of the study is to analyze the frequency, the mechanism of injury and clinical forms of floating bones, and to present the results of their management. Material and Methods: A ten years ongoing retrospective study was held in four trauma departments. Eleven cases of floating bones were identified. The floating bones characteristics such as the injured bone, the patient age and sex, the mechanism of injury, the dislocations directions, the associated complications, the treatment and the outcome were studied. Results: Nine male and two female patients, with a mean age of 37 years [19 - 65 years range] presented a concurrent bipolar dislocation of one bone or a group of bones. They sustained a road traffic accident (n = 5), a workplace accident (n = 3), a fall from height (n = 2), and a sport accident (n = 1). The clavicle (n = 3) and the first metatarsal (n = 3) were the most frequently involved. The others floating bones were the radius-ulna complex (n = 1), the radius-lunatum complex (n = 1), the first metacarpal (n = 1), the first phalanx (n = 1) and the femur (n = 1). The floating bones ends displacement occurred in the sagittal plane (the forearm, the femur, the first phalanx and the first metatarsal) and in the horizontal plane (the clavicle, the first metatarsal and the first metacarpal). We defined direction displacements as bidirectional asymmetric (n = 10) or unidirectional symmetric (n = 1). Associated complications were fractures (wrist, hip, tarso-metatarsal joints) and wounds (fingers, metatarso-phalangeal joint). Dislocations were treated conservatively (n = 5) and surgically (n = 17) with excellent results (n = 13/16 joints). Three patients were lost of view. Conclusion: Our study described the characteristics of this exceptional injury. For any joint dislocation, we promote the systematic examination of the other end of the dislocated bone.

Adult Sex Discrimination Using Metric Measurements of Hand Digital Radiographs in Egyptian Population

Objective: The aim of the present study is to discriminate functions for sex determination in a subjected sample of the Egyptian population using the morphology of metacarpals and phalanges for gender comparison. Furthermore, the measurements discussed in this study will aid in predicting the differentiation independently and guaranteeing sex determination in the subjected population individually. Methods: Forty measurements were taken from the right metacarpals and phalangeal bones of 100 subjects, whose ages ranged from 19 to 60. Moreover, the measurements of nine metacarpals and four phalangeal bones were used for sex discrimination in each sample population. Results: Males had significantly greater mean values (P < 0.05) for the lengths of the metacarpals and the proximal phalangeal bones of all right-hand fingers than females. The cut-off value and the accuracy percentage for precise sex classification of males and females using individual and grouped bones showed that a value higher than the marking point classified an individual as male and that a lower value suggested female. Besides, the multiple stepwise discriminant functional analysis of the most predictable internal variables of the metacarpals revealed a cross-validated sex classification accuracy of 100%. In contrast, the most predictable internal variables of the phalanges showed a cross-validated sex classification accuracy of 93%. Conclusion: The results revealed a new forensic suggestion for the determination of sex based on the measurements of the metacarpals and the phalanges. Moreover, various discriminant equations were applied for the declaration of this conceivable recommendation.

微型钢板与克氏针内固定治疗掌指骨骨折的Meta分析

目的系统评价微型钢板内固定与克氏针内固定治疗掌指骨骨折的疗效。方法计算机检索万方、CNKI、CBM、VIP、Pubmed、Embase和Cochrane Library数据库。收集关于微型钢板与克氏针内固定治疗掌指骨骨折的对比性研究,对收集的研究结果进行质量评价并提取相关数据,用RevMan 5.3软件进行Meta分析。结果共纳入6项前瞻性随机对照研究,8项回顾性队列研究。Meta分析结果显示,两组患者的住院时间(WMD=-1.32,95%CI:-3.17~0.52,P>0.05)和手术时间(WMD=21.46,95%CI:-13.08~56.00,P>0.05)无明显差异,但是微型钢板组在骨折愈合时间(WMD=-1.53,95%CI:-1.90^-1.17,P<0.05)、关节活动功能优良率(RR=1.18,95%CI:1.13~1.25,P<0.05)、伤口感染率(RR=0.39,95%CI:0.25~0.61,P<0.05)和固定物不良事件发生率(RR=0.35,95%CI:0.17~0.73,P<0.05)方面更具优势。结论现有证据表明,在总体上微型钢板治疗掌指骨骨折的疗效较克氏针更好。

新疆维吾尔族青年手长、掌长与身高的关系

对１９８８年测量的６０９名（年龄１８～２４岁）新疆维吾尔族青年手长、掌长及身高，按年龄和性别分组，计算了手长、掌长和身高的平均值，身高与手长、掌长的比值，并提出了由手长、掌长推算身高的简单公式和回归方程。

针刺第二掌骨侧全息穴位群治疗急性运动损伤的体会

针刺第二个掌骨侧全息穴位群并配合肢体活动或配刺某些经穴,治疗运动中出现的腰部及四肢软组织的急性损伤17例,操作简便而安全,能快速减轻疼痛和消肿,总有效率达100％。

第五掌骨基底部骨折伴腕掌关节脱位的诊断及治疗

目的探讨第5掌骨基底部骨折伴腕掌关节脱位(反Bennett骨折)的早期诊断及治疗方法。方法 2008年1月-2012年3月,收治26例反Bennett骨折患者。男20例,女6例;年龄19～48岁,平均26岁。致伤原因:拳击伤19例,跌伤3例,重物砸伤3例,挤压伤1例。骨折按照Lundeen分型标准:A型8例,B型9例,C型3例,D型6例。受伤至手术时间1～8 d,平均4 d。均取第5掌骨背侧L形切口,骨折复位后克氏针、螺钉或钢板内固定。结果术后患者切口均Ⅰ期愈合,无切口感染、血肿及皮肤坏死等早期并发症发生。26例均获随访,随访时间8～24个月,平均12.5个月。X线片示骨折均愈合,愈合时间为6～8周,平均6.5周。无骨延迟愈合及骨不连发生,无第5腕掌关节脱位及半脱位;2例有轻度骨关节炎表现。术后8个月手功能按照中华医学会手外科学会上肢部分功能评定试用标准评定:获优22例,良3例,可1例,优良率96.2%。结论反Bennet骨折经早期诊断、及时切开复位、合适的内固定治疗,可取得满意近期疗效。