the role of external fixators in the treatment of thumb...
TRANSCRIPT
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Henryk Guzik, Damian Kusz
Department of Orthopedics and Traumatology Medical University of Silesia - Katowice Head of Department: Prof. dr hab. n. med. Damian Kusz
The role of external fixators
in the treatment of thumb fractures
THE 2nd INTERNATIONAL TRAUMA SYMPOSIUM
Injuries of the Upper Extremity - from top to bottom
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Introduction
Comminuted, intra-articular thumb fractures, with extensive soft tissue
injuries, are a serious medical problem, often difficult to treat by open
stabilization with plate and screws or percutaneous stabilization
with K wires.
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Introduction
Treatment outcomes of depend on the effective stabilization
of fragments, correct axial alignment of fragments and early
motion.
There are only few reports and publications about the
described types of fractures in the thumb and methods
of their treatment, in particular, comparing the available
procedures.
Dynamic distraction external fixation (DDEF) meets all these
conditions.
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Introduction
Treatment with commercially available stabilizers it is not always possible
due to their poor availability and high cost.
The stabilizers made of inexpensive K wires, according to the principles
set out, among others by Slade, Agee, Inanami, Suzuki or Allison, seems
to be the most advantageous solution.
The lack of articular surface reposition by ligamentotaxis may require
additional open reduction and bone grafting, or additional percutaneous
fixation with K wires.
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Method
Dynamic distraction external fixation by Slade
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Method
Dynamic distraction external fixation by Slade
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Method
Dynamic distraction external fixation by Slade
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Method
Dynamic distraction external fixation by Slade
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Method
Dynamic distraction external fixation by Slade
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Method
Dynamic distraction external fixation by Slade
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Method
Dynamic distraction external fixation by Slade
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Method
Dynamic distraction external fixation by Slade
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Method
Active motion were started from 2nd day after the surgery.
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Method
The fixator was removed in the outpatient settings five weeks after surgery.
Then the process of rehabilitation continued - active and passive
motion, diadynamics, whirpool massage, magnetotherapy, laser therapy.
We evaluated the result 5 months after bone union was achieved, using
Kapandji test and the DASH questionnaire.
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Case 1
Male, 58 years old, skiing accident –
brain commotion, left proximal humerus fracture,
comminuted intra-articular fracture of right thumb (base of proximal
phalanx).
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Case 1
DASH questionnaire – 58 pkt.
Kapandji test - 9- 9
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Case 2
Male, 42 years old, explosion of gas cylinder –
comminuted intra-articular fracture of right thumb (base of proximal
phalanx and base of distal phalanx).
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Case 2
DASH questionnaire – 34 pkt.
Kapandji test - 10- 9
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Case 3
Male, 34 years old, ZOO employee, crocodile bite –
comminuted intra-articular fracture of left thumb (head of proximal
phalanx).
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Case 3
DASH questionnaire – 33 pkt.
Kapandji test - 10- 9
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Conclusions
Dynamic distraction external fixation by Slade in comminuted, intra-
articular fractures of thumb, with extensive soft tissue injuries seems
to be a very good treatment option, easily available, inexpensive,
and above all associated with good treatment outcomes.
Positioning the thumb in opposition to the other fingers is very good
for placement of the stabilizer, the subsequent use of the device,
and acceptance by the patient.
The disadvantege of this method seems to be imprecise control
distraction force, which can affect the time of achieving the bone
union, however, it does not seem to affect the final functional result
of treatment.
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Thank you for your attention