Closed Reduction And Kirschner Wire Fixation In Treating Fracture Of The Base Of The First Metacarpus Under The C-arm Lfuoroscopy

Research Background and Objective:The hand is a particularly complex organ and plays an important rolein our daily life and production. The first carpometacarpal joint, as themost important in the hand, comprises the first metacarpal base andtrapezium, which forms a unique saddle joint. This joint has a critical rolein the thumb abduction and opposing functions. The first metacarpal basefracture is a common condition among hand bone and joint injuries andwill vertically damage the first carpometacarpal joint, resulting inunstable fracture. Considering the special anatomical structure of the firstcarpometacarpal joint, relatively large number of clinical types, andvarious therapies with varying efficacy, improper treatment can lead tofracture malunion and even may cause concurrent traumatic arthritis atlate stage, which exerts a serious impact on thumb abduction andopposing movements and further affects hand functions. Consequently, itis extremely vital to establish a method with easy operability, reliablefixation and satisfactory efficacy in the treatment of the first metacarpalbase fracture. This is also a topic that is actively explored by clinicians. Inthis paper, the clinical efficacy of internal fixation treatment of the firstmetacarpal base fracture using closed-reduction Kirschner wires under C-arm condition was explored.Materials and Methods:The clinical data of nineteen eligible patients with the firstmetacarpal base fracture included in this study, who were admitted to theHand Surgery Clinic or wards of China-Japan Union Hospital of JilinUniversity from September2012to January2015and were treated withinternal fixation using closed-reduction Kirschner wires under C-armcondition and plaster slab external fixation, was analyzed in this paper.There were11males and8females; the ages range from27to65yearswith an average of39.5years. The duration from injury to surgery wasbetween1.5h and3d with an average of10.3h. According to the Greentyping, there were2cases of Bennett fracture type I and17cases of adultextra-articular fracture type III. Follow-up was carried out in all patientsusing following criteria:①TAM system evaluation method were used toevaluate finger active motion and the condition of fracture healing;②the method by S lgeback et al. was used to evaluate patient subjectiveexperience;③the goniometer was used to measure the flexion andextension range of motion (ROM) of the first carpometacarpal joint andthe thumb flexion and extension ROM, and the Jamar dynamometer wasused to measure the grip strength, all of which were then compared withthe healthy side. Results：The operation duration ranged from15-45min with an average of30min; the postoperative hospital stay lasted1-3d. All of patients werefollowed up after surgery, and the follow-up time was6-12weeks with anaverage of6.5weeks. Of these19cases, The fractures of all patients werehealed, and the healing time was4-6weeks with an average of5.5weeks.According to TAM system evaluation method and patient subjectiveexperience,14cases were graded as excellent,4as good and1as medium,indicating an excellent-good rate of94.7%. Of them, pin site infectionwas reported in1case, and Kirschner wire loose in2cases. Nodifferences in the flexion and extension range of motion (ROM) of thefirst carpometacarpal joint, the thumb flexion and extension ROM andgrip strength were statistically significant when compared with thehealthy side.Conclusion:Internal fixation treatment of the first metacarpal base fracture usingclosed-reduction Kirschner wires under C-arm condition is featured withsimple operation, satisfactory reduction, reliable fixation, less fracturehealing time, early realization of functional exercise as well as effectivelyreduced incidence of postoperative joint pain, limited joint mobility andtraumatic arthritis. The clinical efficacy is satisfactory, suggesting itsvalue for clinical promotion. The procedure has the following characteristics:①simple operation,no surgical incision, no effect on the local skin blood circulation, reducedpostoperative infection chance;②no periosteal stripping, no damage tothe integrity of blood circulation and joint capsule on the fracture end,benefits for fracture healing;③reduced chances of tendon adhesions andjoint contractures;④shortened hospital stay providing the dischargewithin three days after surgery;⑤the ability to complete follow-up andfixture removal in the clinic to avoid secondary damage;⑥low price ofKirschner wire, thus reducing the financial and emotional burdens ofpatients;⑦reduced risks of surgery for patients with other accompanieddiseases (heart disease, hypertension, diabetes, etc.).