- Email: [email protected]
FRACTURES OF METACARPALS: EVALUATION OF RESULTS AFTER TREATMENT WITH ORIF OR A MINI EXTERNAL FIXATOR
ARTICLE IN PRESS 38
8.3 THE GREAT ORMOND STREET LADDER – A METHOD FOR SCORING PAEDIATRIC HAND FUNCTION
P. Smith, G. D. Smith and G. Dowling Great Ormond Street, UK Background: Functional assessment of the paediatric hand is essential in evaluating existing problems and assessing the outcome of surgical interventions. Existing scoring systems are time-consuming and impractical or fail to allow for those where hand morphology is abnormal. Aim: Our aim was to develop a simple, rapid and reliable method for scoring paediatric hand function. Methods: We have distilled the process of assessing hand function down to the analysis of seven tasks. These tasks, or key performance indicators of hand function, may be viewed as rungs on a ladder of functional ability. A score, indicating the level achieved on the ladder, is generated by awarding a 0, 1 or 2 rating to the competence with which each task is completed. A maximum score of 14 is achievable. The investigating team of three plastic surgeons applied the scoring system to 30 patients in the congenital hand anomalies clinic at Great Ormond Street Hospital. Results: The ladder concept provided a practical assessment of function across a broad range of paediatric hand deformities. There was minimal interobserver variability using this scoring system. The scoring system simplified analysis of the problems and decision–making with complex cases and made prognosis for outcome more predictable. Conclusion: The Great Ormond Street Ladder provides guidelines for the structured observation of hand function in children and clarifies the decision making process in complex cases. 10.1016/j.jhsb.2006.03.072
8.4 FRACTURES OF METACARPALS: EVALUATION OF RESULTS AFTER TREATMENT WITH ORIF OR A MINI EXTERNAL FIXATOR
S. Varitimidis, Z. Dailiana, D. Agorastakis, M. Hantes, D. Giotikas and K. Malizos University of Thessaly Medical School, Larissa, Greece Introduction: Operative treatment of the metacarpal fractures includes a variety of methods. The purpose of this study is to evaluate retrospectively the results after treatment of metacarpal fractures in two groups that were treated with internal fixation with plates and screws or with external fixation. Material and methods: Ninety fractures were treated from February 2000 to March 2005 with the methods of
THE JOURNAL OF HAND SURGERY VOL. 31B No. S1 JUNE
2006
open reduction and internal fixation or with the application of an external fixator. Fifty-six were treated with open reduction and internal fixation and 34 fractures were treated with external fixation. Indications for ORIF included transverse, oblique, spiral fractures without an extensive injury to soft tissues. The applied hardware was very low profile plates and screws. External fixation was used in fractures with extensive comminution and injury to soft tissues, in fractures with bone defects and in fractures with infection. Results: Mean follow-up was 32 months (8–50) for the group treated with ORIF and 22 months (7–37) for the group treated with external fixator. The extensor fixation device was removed after a mean of 33 days (28–52). In this group 28 patients had good or excellent results while six patients with severe combined injuries had poor results. In the group of patients with ORIF 48 of the 56 patients had good or excellent results. For evaluation of hand function the DASH score was used. It was six (0–56) for the ORIF group and four (0–15) for the external fixation group. Discussion and conclusion: Following the appropriate indications and techniques both methods proved to be very efficient in the treatment of metacarpal fractures. Active mobilization is achieved early with both methods. The external fixator can be used in more severe injuries and in fractures with infection but its cost is higher. The surgeon must be familiar with the safe paths in the hand in order to avoid injury to tendons or nerves and vessels. 10.1016/j.jhsb.2006.03.073
8.5 CONSERVATIVE VERSUS OPERATIVE TREATMENT OF ISOLATED PHALANGEAL AND METACARPAL FRACTURES: A RANDOMIZED, PROSPECTIVE STUDY
A. Zyluk and T. Budzynski Pomeranian Medical University Szczecin, Szczecin, Poland Objective: To compare the effectiveness of conservative and operative treatment of isolated digital and metacarpal fractures with regard to objective (grip strength, range of motion and extension loss of fingers) and subjective parameters (pain, dexterity of the hand assessed with DASH questionnaire) Patients and methods: Over the period of 2004 and 2005 a total of 60 patients (44 men, 16 women, mean age 49 years) with isolated, displaced phalangeal or metacarpal fractures were identified. Thirty of them were treated conservatively with reduction and immobilization in a cast. The other 30 were operated on, and fractures were stabilized with K-wires, screws or plates. Patients were randomized to the conservative or operative method of
8.3 THE GREAT ORMOND STREET LADDER – A METHOD FOR SCORING PAEDIATRIC HAND FUNCTION
P. Smith, G. D. Smith and G. Dowling Great Ormond Street, UK Background: Functional assessment of the paediatric hand is essential in evaluating existing problems and assessing the outcome of surgical interventions. Existing scoring systems are time-consuming and impractical or fail to allow for those where hand morphology is abnormal. Aim: Our aim was to develop a simple, rapid and reliable method for scoring paediatric hand function. Methods: We have distilled the process of assessing hand function down to the analysis of seven tasks. These tasks, or key performance indicators of hand function, may be viewed as rungs on a ladder of functional ability. A score, indicating the level achieved on the ladder, is generated by awarding a 0, 1 or 2 rating to the competence with which each task is completed. A maximum score of 14 is achievable. The investigating team of three plastic surgeons applied the scoring system to 30 patients in the congenital hand anomalies clinic at Great Ormond Street Hospital. Results: The ladder concept provided a practical assessment of function across a broad range of paediatric hand deformities. There was minimal interobserver variability using this scoring system. The scoring system simplified analysis of the problems and decision–making with complex cases and made prognosis for outcome more predictable. Conclusion: The Great Ormond Street Ladder provides guidelines for the structured observation of hand function in children and clarifies the decision making process in complex cases. 10.1016/j.jhsb.2006.03.072
8.4 FRACTURES OF METACARPALS: EVALUATION OF RESULTS AFTER TREATMENT WITH ORIF OR A MINI EXTERNAL FIXATOR
S. Varitimidis, Z. Dailiana, D. Agorastakis, M. Hantes, D. Giotikas and K. Malizos University of Thessaly Medical School, Larissa, Greece Introduction: Operative treatment of the metacarpal fractures includes a variety of methods. The purpose of this study is to evaluate retrospectively the results after treatment of metacarpal fractures in two groups that were treated with internal fixation with plates and screws or with external fixation. Material and methods: Ninety fractures were treated from February 2000 to March 2005 with the methods of
THE JOURNAL OF HAND SURGERY VOL. 31B No. S1 JUNE
2006
open reduction and internal fixation or with the application of an external fixator. Fifty-six were treated with open reduction and internal fixation and 34 fractures were treated with external fixation. Indications for ORIF included transverse, oblique, spiral fractures without an extensive injury to soft tissues. The applied hardware was very low profile plates and screws. External fixation was used in fractures with extensive comminution and injury to soft tissues, in fractures with bone defects and in fractures with infection. Results: Mean follow-up was 32 months (8–50) for the group treated with ORIF and 22 months (7–37) for the group treated with external fixator. The extensor fixation device was removed after a mean of 33 days (28–52). In this group 28 patients had good or excellent results while six patients with severe combined injuries had poor results. In the group of patients with ORIF 48 of the 56 patients had good or excellent results. For evaluation of hand function the DASH score was used. It was six (0–56) for the ORIF group and four (0–15) for the external fixation group. Discussion and conclusion: Following the appropriate indications and techniques both methods proved to be very efficient in the treatment of metacarpal fractures. Active mobilization is achieved early with both methods. The external fixator can be used in more severe injuries and in fractures with infection but its cost is higher. The surgeon must be familiar with the safe paths in the hand in order to avoid injury to tendons or nerves and vessels. 10.1016/j.jhsb.2006.03.073
8.5 CONSERVATIVE VERSUS OPERATIVE TREATMENT OF ISOLATED PHALANGEAL AND METACARPAL FRACTURES: A RANDOMIZED, PROSPECTIVE STUDY
A. Zyluk and T. Budzynski Pomeranian Medical University Szczecin, Szczecin, Poland Objective: To compare the effectiveness of conservative and operative treatment of isolated digital and metacarpal fractures with regard to objective (grip strength, range of motion and extension loss of fingers) and subjective parameters (pain, dexterity of the hand assessed with DASH questionnaire) Patients and methods: Over the period of 2004 and 2005 a total of 60 patients (44 men, 16 women, mean age 49 years) with isolated, displaced phalangeal or metacarpal fractures were identified. Thirty of them were treated conservatively with reduction and immobilization in a cast. The other 30 were operated on, and fractures were stabilized with K-wires, screws or plates. Patients were randomized to the conservative or operative method of