Clinical Application Of Mini Hook Plate For Management Of Avulsion Fractures Of The Hand

ObjectiveTo investigate the clinical effect of mini hook plate in the treatment of avulsion fracture of finger joint.MethodsFrom March 2017 to November 2019,24 patients with avulsion fracture of finger were treated with fracture open reduction and internal fixation with mini hook plate.There were 14 males and 10 females,aged 26 ~ 62 years,with an average age of 34.4years.The time from injury to surgery was 4 hours to 35 days,with an average of 9days.There were 19 cases of fresh injuries(< 2 weeks)and 5 cases of old injuries(> 2weeks).All patients had avulsion fractures involving the articular surface.There were9 cases of avulsion fractures of the lateral collateral ligament,10 cases of avulsion fractures of the volar plate and 5 cases of avulsion fractures of the central bundle.There were 5 cases of thumb,4 cases of index finger,3 cases of middle finger,6 cases of ring finger and 6 cases of little finger.There were 8 cases of metacarpophalangeal joint injury and 16 cases of interphalangeal joint injury.There were 10 cases on the right hand and 14 on the left.There were 23 closed injuries and 1 open injury.The clinical manifestations and examination manifestations were swelling and limited movement of the injured joint,and obvious local tenderness.In addition,in patients with avulsion of collateral ligament,the lateral stress test was more than 50% higher than that of the healthy side.X-ray showed that the phalangeal basal fracture of the corresponding joint involved the articular surface,and the fracture block wasaccompanied by displacement and rotation to different degrees.Patients with avulsion fracture of the volar plate presented damaged joints accompanied by dorsal subluxation to varying degrees.X-ray showed that the fracture block was a palmar fracture of the phalangeal base,involving the articular surface,and the fracture block was obviously displaced.The X-ray findings of the patients with avulsion at the central bundle showed avulsion fracture at the dorsal margin of the base of the middle phalanx,with obvious displacement of the fracture block and obvious button deformity in some patients.ResultsAll patients were followed up for 3 to 20 months,with an average of 14 months.The last postoperative X-ray examination of all patients showed that the fracture line disappeared.the fracture was healed and the joint surface was smooth.The fracture healing time was 4-8 weeks,with an average of 5.8 weeks.All joints were stable,movement was coordinated,and there was no subluxation.No postoperative complications such as incision infection,finger numbness,and skin necrosis occurred in all patients.All patients returned to work within 2 months.During the follow-up,none of the 5 patients with avulsion fracture at the central bundle stop developed boutonniere deformity after surgical treatment,and one patient had 30° of limited extension of the proximal interphalangeal joint.The avulsion fracture of the volar plate in 2 patients was limited in flexion by about 25° compared with the healthy side.Later,the mini hook plate was taken out in our hospital,and part of the soft tissue around the joint was found to be conglutinated and released.A total of 19 of the 24 patients were removed again,with a removal rate of 79.17%.At the last follow-up,finger function was assessed using the Saetta standard and TAM(total active activity).Saetta standard evaluated finger function as excellent in 16 cases,good in 7cases and fair in 1 case excellent and good outcomes accounted for 95.8%.TAM function scores were excellent 18 cases,good 5 cases,and fair 1 case,excellent and good outcomes accounted for 95.8%.ConclusionHook plate is a simple device,which can be easily made by using existing materials,and has obvious biomechanical advantages over traditional fixation methods in the treatment of avulsion fractures involving small articular surfaces.And it can play a good effect in fixation of avulsion fracture of fingers involved in articular surface.Hook plate is an effective and feasible method to treat avulsion fracture of finger joint.