제1 수지 수근중수간관절 손상

Abstract

The treatment of 21 trapeziometacarpal joint(TMC) injuries was studied to provide an understanding of the pathomechanics and treatment principles for a good functional outcome. TMC joint has wide range of motion, complex articular surface, and greater muscular pull than other joints in hand. Injury of TMC joint can easily cause limitation of motion, deformity, pain, weakness, and posttraumatic osteoarthritis. Especially, the instability of TMC joint causes prolonged subluxation and weariless of pinch and grip. Twelve Bennett's fractures, 2 Rolando's fractures, 5 epiphyseal injuries, 1 pure dislocation without fracture, and 1 trapezium fracture were treated. Four Bennett's fractures and 3 epiphyseal injuries were immobilized in plaster cast after closed reduction. Five Bennett's fractures and 1 pure dislocation were treated by closed reduction and percutaneous pinning. Three Bennett's fractures and 2 epiphyseal injuries were treated by open deduction and pinning. Two comminuted Rolando's fractures were treated by open reduction, pinning, and intermetacarpal external fixation. At follow up after median 13 months, 6 Bennett's fractures, 2 Rolando's fractures, 2 epiphyseal injuries were satisfactory. The others showed pain, deformity, motion restriction, weakness, or subluxation. We concluded that restoration of articular surface, internal fixation againt the muscular pull, and stabilization of the 3oint were mandatory for a satisfactory outcome.