Metacarpal and fingers phalanges fractures make up 10 % of all fractures of the
bone of the skeleton and 50 % of them arise as a result of an industrial injury.
Fractures of metacarpal bones are found in 30 % of cases of all fractures of the bones
of the hand. The urgency of this problem in recent years is due to a significant number of
complications and unsatisfactory results of short tubular bones fractures treatment.
They make up 9-25.3 % of patients in orthopedic hospitals. The reason for this trend is often non-known principles of short tubular bones fracture treatment, especially the
correct fragments reposition and stable fixation, adherence to deadlines fragments
immobilization maximum preservation of limb function, and violation of rules of
different osteosynthesis methods and imperfection some hardware.
This study is based on the results of the examination and treatment of 154
patients (23 female and 131 male) with a diagnosis of metacarpal bone (bones), aged
16 to 75 years. For conservative treatment 70 patients were treated, surgical - 84
patients.
Depending on the type of treatment received, all patients were divided into two
clinical groups. The first group consisted of 70 patients who received conservative
treatment. The second group includes 84 patients who have undergone surgical
treatment. Patients in both clinical groups were comparable in terms of age, gender,
type, and localization of fractures. Patients treated conservatively were divided into 2
subgroups: 1) those treated in the classical (long) gypsum band at the position of
fingernail extension; and 2) those treated in the functional band with the possibility of
movements in MF joints of the hand. The patients undergoing surgical treatment were
also divided into 2 subgroups: 1) k-wires osteosynthesis and 2) osteosynthesis of
metacarpal bones fractures by mini plates. The studies included a detailed analysis of complaints and anamnesis. Particular attention was paid to the nature, mechanism of injury and the period from injury to medical treatment. In addition to clinical examination, instrumental, sonographic, Xray and MRI tests were performed. Using personal data (DASH), the patient's
individual relation to the function of the injured hand was determined, and the
objective indicators of the hand function (AAHS) were investigated.
The result of the study was the following: the study of the features of the clinical
picture, the data of biomechanical and experimental studies, the state of bone and
metacarpal-phalangeal joints, as well as the development and implementation of new
methods for the prevention of poor results that will significantly improve the quality of
treatment in patients with fractures 2-5 metacarpal bones. Based on sonographic
examination of the metacarpal-phalangeal joints, we managed to establish the
preconditions for the establishment of extension contractions in patients with fractures
of metacarpal bones. Real-time modeling of the bone fracture and evaluation of bone-fixation
interaction in the system was performed. An analysis of biomechanical properties of
various metal fixators used for metal osteosynthesis of fractures of the metacarpal
bones was carried out. A comparative analysis of the biomechanical properties of
various fixators was carried out, as well as the metal fixator proposed and developed.
Implementation of the developed metal fixator, which will significantly improve
the results of surgical treatment of head and neck fractures of 2 to 5 metacarpal bones,
and will make the operative interventions on this subject less traumatic and more
effective. Development of pathogenetically grounded method of conservative and
operative treatment of patients with fractures of 2 - 5 metacarpal bones.
The introduction of a comprehensive approach to treatment, rehabilitation
systems with the application of the proposed methods can improve the results of treatment, in particular, improve the quality of life of the selected category of patients,
reduce the disability.
