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Treatment of diaphyseal fractures of the metacarpal bones
and the given indicator was sharply increased with increase of severity of disease. Factor of apoptosis FasL in focal and polyfocal forms of alopecia areata was 0.9 ± 0.19 pg/ml, subtotal and total forms — 2.42 ± 0.16 pg/ml, universal form — 2.97 ± 0.32 pg/ml, whereas factor of apoptosis FasL in control group was 0.036 ± 0.01 pg/ml.
Conclusions: Thus, studies carried out permit to conclude that proteins of families FGF and FasL are responsible for a fine regulation of phases of vital cycle of hair follicles. It is possible that studies aimed at regulation of concentration of these proteins in hair follicles in alopecia areata form a basis for improvement of therapy of the given disease.
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9. Hoeben A., et al. Vascular endothelial growth factor and angiogenesis.//Pharmacology Review. - 2004. - 56. - P. 549-80.
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Khaydarov Azizjon Kosimovich, Tashkent Medical Academy, Republic of Uzbekistan E-mail: [email protected]
Treatment of diaphyseal fractures of the metacarpal bones
Abstract: It was presented the experience of theapplication of stable osteosynthesisby three Kirschner wires on diaphyseal fractures of the metacarpal bones on 74 patients. Indications for osteosynthesiswere opened (6 %), closed (94 %), non-united, mal-unitedfracturesand false joints of metacarpal bonesdiaphysis. Patients were performed intraosseous anesthesia atdistalepimetaphysisarea of radial bone anddescribeda method of operation extra-medullaryosteosynthesis using three Kirschner wires. Also, describedmethod of wedge osteotomy for full recovery of hand function. Good results were obtained in 83.1 % of patients, satisfactory at 13.6 %, and unsatisfactory results in 3.4 % of patients.
Keywords: metacarpal bones, wedge osteotomy, diaphys , fracture.
Introduction
Treatment of fractures of the metacarpal bones isstilla difficult part of Hand Surgery. At the recent time, there is no singleapproach to the choice of treatment for different diaphyseal fractures of the metacarpal bones. Conservative treatment is not always sufficient retention for consolidation of bone fragments and often leads to secondary fragments-displacement after reduction.
Basically among surgeries used intra and extramedullary-ostesinthesis alsoextrafocalexternal fixation and diafixation-
method. Intramedullary osteosynthesis pin allows for reliable fixation of fragments, provides extra-articular holding metal fixating contributes less traumatizationinterosseal muscles and longitudinal arch brush, can be apply for multiple fractures of metacarpal bones. The disadvantage is the inability to intramedullary nailing accurate repositioning of the high rigidity and bending pin curvature mismatch metacarpal bone and the complexity of its removal after bone fragmentsconsolidation. As extramedullary stable osteosynthesis of tubular bones of the hand has been used successfully mono-local extramedullary
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Section 8. Medical science
plate with screws AO system and other similar structures. The disadvantage is the difficulty of the screw through the metacar-pals, the need for re-operation. Wider application finds extra fo-calosteosynthesis external fixation. But this method is indicated only at fragmented, peri- and intra-articular fractures. Despite the simplicity and reliability of the method diafixation, its application is limited for multiple fracture of the metacarpal bone and does not eliminate the rotational displacement ofbone fragments. To eliminate those disadvantages, we have developed a modified method diafixationbone fragments fracture of the metacarpal bones of the hand.
Material and Methods
We observed 74 patients between 2010 and 2014 in the department of hand surgery with injury of metacarpal bones. Of these, 68 were male, female. Age was from 18 to 53 years, which is the most able-bodied. It was identified street injury 33 %, household trauma 45 %, production and other injuries in 22 % of patients. Injury was observed in the right hand 93 %, left in 7 % of patients. The open fractures were 6 %, 94 % were closed; patients have been admitted with non-united, mal-unit-ed fractures and false joints of the metacarpal bones.
The indications for this technique were: opened, closed, non-united, mal-uniteddiaphyseal fractures and false joints of metacarpal bones. This method is not suitable for intraarticular, metadiaphyseal, fragmented and spiral fractures.
Fig.1. X-ray after surgery Surgical technique
The operation was performed under the intra-osseous anesthesia with 0.5 % solution of procaine (60-70 ml.) through the distal epimetaphysisofradius (anesthesia usually occurs within 5-10 minutes after the anesthetic injection and enforce surgery with duration of 1-1.5 hours). By semi ovalincision on dorsal radial surface approached the site of the fracture I, II, III metacarpal bones, and to approach to the IV and V metacarpal bone was incised on the dorsal ulnar surface in the projection damaged metacarpal bones. The length of the wound was in the ranged of 3-4 cm. Then, edges of the wound were diluted by a silk skin clamp. After that sharp and blunt withdrawn extensor tendons the fracture site was exposed, removed blood clots, tissue interposi-
tion eliminated. After that repositioned bone fragments and fixed two crossed Kirschnerwires through both fragments and one through the distal fragment is perpendicular to the axis of the metacarpal bones, which provided a solid fixation and exclude rotary displacement of fragments.
Example #1 (Fig. 1):
Patient S., 23 years, case # 1618 from 08.12.2011, was admitted to the hospital with the diagnosis: Closed oblique fracture of 4 metacarpal of the right hand.
The patient was operated 10.12.2011, under the intraosseous anesthesia 0.5 % solution of Procaine, after treatment of the surgical field with Betadineheldsemi ovalinci-sion along the dorsum of the hand at the level of the fracture length of 4 cm. layers exposed metacarpal bone. Hand-stage reduction, correction of angular displacement, then fragments of bones strengthen 2 crossed wires and one carried out through the distal fragment is perpendicular to the axis of the metacarpal bone, which provide a solid grip and eliminate the rotational displacement of fragments. After surgery, superimposed plaster splint for 4-5 weeks. Made control radiograph. Sutures are removed after 15 days, and after 3-4 weeks plaster splints.
When non-united wrong fused fractures and false joints of metacarpal bones of the hand were a significant deformation of the metacarpals it was clear that limitation of motion of the metacarpal- phalange joints of the fingers. Under these fractures we use the following method.
The objective of the proposed method is the elimination of the defect of the deformed segment, reducing trauma, with the exception of postoperative complications, reducing the time of treatment. To solve the problems a method of treating non-united, fused wrong, false joints and fractures of the metacarpals with angular deformity, including osteoclasis, one-step manual reposition, correction of angular displacement c followed by the imposition of plaster splints, characterized in that the front osteoclasis produce osteotomy properly fused bones under angle of 45 degrees and a length of 5-6 mm., and then strengthen the bone fragments 2 crossed spokes and one carried out through the distal fragment is perpendicular to the axis of the metacarpal bone, which provide a solid grip and eliminate the rotational displacement of fragments.
When non-united fractures and false joints metacarpal bones to fix two crossed Kirschner wires, plastic auto bone made to improve the regeneration of the damaged bone reposition axis.
This method eliminates the anatomical defect deformed segment, prevent the occurrence of contractures. After surgery 15 days remove sutures, plaster splints immobilized for 3-4 weeks after surgery. After the X-ray control after 3-4 weeks (this corresponds to the period seam) removed the plaster splints.
When isolated diaphysis fractures of fresh dates seam fragments were 1-1.2 months. When non-united fractures and wrong intergrows consolidation occurs within 1.5-2 months.
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Treatment of diaphyseal fractures of the metacarpal bones
The Results
Long-term results of treatment in a period from 1 year to 4 years old were studied in 59 (79.7 %) patients. The evaluation was conducted by an 8-point scale, were taken into account the consolidation of the fracture, the range of mo-
tion in the joints, the presence of pain, return to work. Good results were ascertained in 49 (83.1 %) patients, satisfactory in 8 (13.6 %), poor in 2 (3.4 %). In the study of patients with long-term results, we used the template evaluation criteria of the treatment of patients, which is reflected in the table 1.
Table 1.
Scores of all parameters Scores Gross
Consolidation 0 1 2
The volume of traffic on the CFJ 0 1 2
Pain syndrome 0 1 2
Return to work 0 1 2
Gross
Calculated on a point system with 4 parameters:
1. Consolidation:
a. Full consolidation of 2 points;
b. Meden coalesce 1 point;
c. Consolidation no 0 points.
2. The range of motion:
a. The volume of traffic on the PPS 90°-180° (range
of motion 90°) 2 points;
b. The volume of traffic on the PPS 100°-175°
(range of motion 75°) 1 point;
c. The volume of traffic on the PPS 120°-145°
(range of motion of 25° or less) 0 points.
Table 2. -
Conclusions:
1. In diaphysis fractures of the metacarpal bones of the hand for stable fixation of bone fragments, in our opinion, should be used osteosynthesis with three Kirschner wires, providing the possibility of early movements of the joints of the fingers. This method allows you to start active movements in the inter-phalange joints of the hands and carpal-phalange in the first days after the operation, reducing time disability patients.
3. Pain Syndrome:
a. No pain syndrome 2 points;
b. Slight pain syndrome 1 point;
c. Pain syndrome has 0 points.
4. Return to work:
a. Return to work so 2 points;
b. Return-to-work no 0 points.
The results evaluated in following point system:
• from 8 to 6 points is good;
• 5 do3 points satisfactory;
• of 2 points or less unsatisfactory result.
Results
2. The advantages of these methods are small trauma surgery, accurate comparison of bone fragments, their reliability and controlled fixation with the possibility of early functional loading of the overwhelming number of patients.
3. The method we use stable osteosynthesis in fractures of the metacarpal bones of the hand allows you to get 83 % of good results in the vast majority of patients, which gives reason to recommend it for widespread use in the practice of medical institutions.
New fractures Wrong accretefracture non-unitedfractures Nearthrosis Total
Good 24 18 4 2 49
Satisfactory 1 3 4 1 8
Unsatisfactory - - 1 1 2
Total 25 21 9 4 59
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2. Beidik O. V., O. N. Topographic study trans-osseous osteosynthesis short tubular bones of the hand.//The genius of orthopedics. - 2006. - № 2: 18-21.
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