tailieunhanh - Hand and Wrist Surgery - part 7

Trong trường hợp thất bại có giảm thành công đóng cửa, giảm mở nên được thực hiện. Các khớp có thể được tiếp cận thông qua một đường rạch ngang dọc theo dòng Langer ở cấp độ của khớp carpometacarpal. Giảm khớp carpometacarpal thứ ba là chìa khóa để giảm các khớp còn lại vì điều này chức năng chung | FRACTURES AND DISLOCATIONS OF THE HAND In the event of failure of obtaining a successful closed reduction an open reduction should be performed. The joints can be approached via a transverse incision along Langer s lines at the level of the carpometacarpal joint. Reduction of the third carpometacarpal joint is the key to the reduction of the remaining joints as this joint functions as the keystone of the transverse and longitudinal arches of the hand. K-wire fixation of the reduced joints produces a joint that will remain stable during the course of immobilization. Internal fixation with pins screws or plates can be performed to maintain stability. High-energy injuries often require internal fixation as they are often associated with fractures. In the event of multiple dislocations K-wire fixation of all dislocated joints need not be performed. The second and third carpometacarpal joints should be stabilized as they are the keystones of the hand and the fifth carpometacarpal joint should be stabilized to avoid subluxation and ulnar deviation. The fourth carpometacarpal joint need not be pinned if its adjacent joints have been pinned as the strong inter-metacarpal ligaments are not disrupted and will contribute to stability. After reduction and pinning of the carpometacarpal dislocation the hand should be splinted for pain management and soft tissue rest. After a week gentle active and passive range-of-motion exercises of the fingers and wrist can be performed. The K wires can be removed after 6 to 12 weeks. Patients with concomitant fractures require the longer length of time before K-wire removal. After removal of the K wires progressive active and passive range-of-motion and strengthening exercise should be performed. Complications Percutaneous pinning has seen rare complications. Post-operative stiffness may be present but early and appropriate hand therapy can often eliminate this complication. Fluroscopic guidance may aid in the accurate placement of the K .