| Part one Anatomical study on the insertion of flexor digitorum profundus and extensor tendonObjective: To study the difference of the volar and dorsal insertion of flexor digitorum profundus tendon and extensor tendon in the the base of the distal phalanx.Methods: 10 hand specimen were collected from the anatomical laboratory of the hospital,including 3 left hand cases and 7 right hand cases,all of which were male patients,aged from 24-58 years old.All 2-5 fingers were 10 fingers respectively,and all fingers had no history of traumatic surgery or deformity.The flexor digitorum profundus tendon and extensor tendon of each finger were separated at the level of the distal interphalangeal joint.The distances from the insertion of flexor digitorum profundus tendon and extensor tendon to the volar and dorsal articular surfaces of the distal phalanx were recorded,and the insertion levels of the flexor digitorum profundus tendon and the extensor tendon at the volar and dorsal phalanx were compared.Results: The distances from the articular surface to the proximal insertion point of the flexor digitorum profundus tendon for each finger were as follows: the index finger(2.19±0.27)mm,the middle finger(2.50±0.14)mm,the ring finger(2.23±0.16)mm,and the little finger(1.83±0.19)mm.The distances from the proximal extensor tendon insertion point to the articular surface for each finger were as follows: the index finger(0.12 ±0.02)mm,the middle finger(0.18±0.02)mm,the ring finger(0.12±0.05)mm,and the little finger(0.06±0.01)mm.The difference of each finger was statistically significant(P<0.05).The distances from the middle point of the insertion of the flexor digitorum profundus tendon to the articular surface for each finger were as follows: the index finger(3.73±0.45)mm,the middle finger(4.33±0.45)mm,the ring finger(3.53±0.46)mm,and the little finger(3.16±0.41)mm.The distances from the middle point of the insertion of the extensor tendon to the articular surface for each finger were as follows: the index finger(1.77±0.06)mm,the middle finger(1.76 ±0.20)mm,the ring finger(1.77±0.06)mm,and the little finger(1.47±0.10)mm.The difference of each finger was statistically significant(P<0.05).Conclusion: The insertion point of the extensor tendon at the base of the terminal phalanx is closer to the articular surface than that of the flexor digitorum profundus tendon,which provides anatomical basis for the mechanism of Seymour fracture.Part two Surgical treatment of seymour fractures in children and adolescentsObjective:To discuss the features,treatments and complications of Seymour fracture in children and adolescents.Methods:Retrospectively analyzed 26 children and adolescents suffering from Seymour fractures from January 2013 to November 2015.18 males and 8 females were included aging from 1 year and 1 month old to 17 years old(average 8.2 years old).The patients were treated by debridement,nail removal,nail matrix repair,closed reduction and osteosynthesis with Kirschner wires and splinting in emergency.Antibiotics was kept using till 3-5 days after surgery.Kirschner wires and splints were removed 4 weeks after surgery,and exercises were taken then.Results:The wounds were all healed without infection.Postoperative follow-up was taken for all patients from 3-24 months(average 12.3 months).The fractures were healed for 1-2 months(average 1.4 months)in X-ray check,and no other further complications were discovered such as nonunion,malunion,premature epiphyseal closure or no growth of the nails.One of these developed a nail deformity and did not need other operation.At the last follow-up,one had mild residual 10° extension lag of the distal interphalangeal joint and the flexion returned to normal.There was no significant difference for the motion range of distal interphalangeal joint(flexion 75°and extension 0°)comparing with contralateral side(flexion 78°and extension 0°).Conclusion:The surgery effect for treating Seymour fracture patients is satisfactory by debridement,nail removal,nail matrix repair,closed reduction and osteosynthesis with Kirschner wires and splinting in emergency.Part three Brace fixation for treating mallet finger in childrenObjective: The distal interphalangeal joint subjected to excessive flexion or extension can damage extensor mechanism,and mallet finger deformity occurs.The aim of treatment is to restore mallet finger deformity and to restore DIP extension.Through the retrospective analysis of injury types,treatment time and compliance of outpatients,the therapeutic effect of extension lag of distal interphalangeal joint and the incidence in children with mallet finger deformity was summarized.Methods: Children with mallet finger malformation were retrospectively analyzed in the outpatient department of the second hospital of Tangshan from 2013 to 2017,and the classification and treatment effects of the patients were summarized.By comparing acute mallet finger with chronic mallet finger,bony mallet finger with tendinous mallet finger,different types,and patients' compliance,the angle of extension limitation and the incidence in each group after conservative treatment were obtained and compared.Results: There were 112 mallet fingers of 110 patients,with an average age of 12.9 years,including 78 boys and 32 girls.Most of the patients suffered from sports injuries,and all of them received conservative treatment with braces.The outcomes resulted in a mean extension lag of 8 ° and the residual extension lag incidence of 32%.Patients with bony mallet finger deformity of the distal interphalangeal joint have residual extension lag incidence of 28% and the average extension lag of 6 °;tendinous mallet finger deformity patients have residual distal interphalangeal joint extension lag incidence of 41% and the average extension lag of 12 °.The patients' compliance is very important to prognosis.The patients with poor compliance have residual distal interphalangeal joint extension lag incidence of 45% and the average extension lag of 18 °.The patients with good compliance have residual distal interphalangeal joint extension lag incidence of 21% and the average extension lag of 6°.Conclusion: Children with mallet finger deformity can be treated conservatively and get good results,no matter whether acute or chronic,bony or tendinous,and regardless of Doyle's type and compliance.However,patients with good compliance were better than those with poor compliance.Part four Scar overlapping suture for treating chronic tendinous mallet finger in childrenObjective: To evaluate the effect of scar overlapping suture for treating chronic tendinous mallet finger deformity in children.Methods: Six patients younger than 18 years were investigated retrospectively.The active extensor lags of the distal interphalangeal joint were all more than 40 degrees,and the passive ranges of distal interphalangeal joint motion were normal.They were all treated surgically by scar overlapping suture technique,featuring careful overlapping suture of the extensor scar and temporary transarticular Kirschner wire fixation of the distal interphalangeal joint.Results: Average follow-up was 3.1 years(ranging from 2 to 5 years).All patients made significant improvement in distal interphalangeal joint activity.Three patients achieved full active distal interphalangeal joint extension,whereas 1 patient had a 10-degree extensor lag and 2 patients had 5-degree extensor lags.All patients achieved normal active flexion ranges and full passive motion ranges of distal interphalangeal joint compared with their uninjured side.There was no bone dysplasia,pain,or deformity recurrence.According to Crawford criteria,all patients were graded as excellent.Conclusion: Scar overlapping suture for treating chronic tendinous mallet finger in children is safe and effective.All patients were graded as excellent. |
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