gms | German Medical Science

58. Kongress der Deutschen Gesellschaft für Handchirurgie

Deutsche Gesellschaft für Handchirurgie

12. - 14.10.2017, München

The Quadrangulated External Fixator in Complicated Carpometacarpal Fracture-Dislocations

Meeting Abstract

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  • corresponding author presenting/speaker Moritz Fischer - Kantonsspital Münsterlingen, Münsterlingen, Switzerland
  • Joachim Ganser - Kantonsspital Münsterlingen, Münsterlingen, Switzerland

Deutsche Gesellschaft für Handchirurgie. 58. Kongress der Deutschen Gesellschaft für Handchirurgie. München, 12.-14.10.2017. Düsseldorf: German Medical Science GMS Publishing House; 2017. Doc17dgh073

doi: 10.3205/17dgh073, urn:nbn:de:0183-17dgh0738

Published: October 10, 2017

© 2017 Fischer et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.


Outline

Text

Objectives: Carpometacarpal fracture-dislocations are demanding injuries. They affect the tendon-mechanics and deteriorate the hand function as a whole. In contrast to other hand fractures, it is rather the restoration of skeletal length and axis than the anatomical reconstruction of the joint surface which determines the outcome of treatment.

Method: This presentation is based on a retrospective clinical study of 8 patients, at least 6 months after primary operation. All patients suffered from closed intraarticular fracture-dislocations of carpometacarpal joints, including 2 axial carpal dislocations, 2 Rolando-fractures and 1 complete Bennett-fracture-dislocation. With one exception, all external fixators were administered after closed reduction, mainly by distracting the fragments and relying on ligamentotaxis.

The technique used in this study rests upon two very established principles: First, the very established transfixation of fracture fragments to stable, non-fractured neighboring bones as advocated t.e. by Iselin. Second, the multidimensional, quadrangulated construction of a conventional external fixator.

4 (external fixator-) pins are inserted bicortically into the bone: 2 pins into the unstable, dislocated column, 2 pins into the neighboring stable column. These four corners are linked by 4 (external fixator-) rods. After coupling, but not yet fixing, this quadrangulated frame, the fracture-reduction is accomplished by closed means. The already inserted but not yet tightened external fixator allows for the full use of the operators both hands during this sometimes power-demanding task. While the operator holds the reduction, the assistant tightens the 8 clamps, connecting the pins and rods, and thereby finishes the whole procedure.

The external fixator is left in place for 6-7 weeks. After this period, it is extracted in local anesthesia.

Results: There were no infections, no loosening of the material and no secondary dislocations. All fractures healed with irregularities of the joint surfaces. The patients returned to their original occupation within 52 to 112 days, mean 92 days.

Conclusion: The advantage of the procedure relies on its simplicity: The reduction can be achieved and corrected up to the end without any repositioning of osteosynthesis material. Furthermore, the operator can focus on fracture reduction without worrying about the osteosynthesis. This method of operating sequentially instead of in parallel takes pressure off the surgeon who is treating these demanding injuries.