Author/Editor		Kruščić, Aleksandar; Brodnik, Tomaž
Title		Zdravljenje sklepnih in prisklepnih zlomov dlančnic in kosti prstov z metodo ligamentotakse
Translated title		Healing of articular and periarticular metacarpal and phalangeal fractures
Type		članek
Source		Zdrav Vestn
Vol. and No.		Letnik 72, št. Suppl 1
Publication year		2003
Volume		str. I-83-90
Language		slo
Abstract		Background. Primary treatment of 779 closed epiphysial, diaphyseal, comminutive, oblique and periarticular fractures of metacarpals and phalanges was carried out with painless reposition and fixation with a plaster splint. In 435 cases, fracture slides occurred after one week. For correction, the ligamentotaxis method with aluminium (Alu) splint and Softcast plaster was used. This method allows the retaining of a good position of fractured fragments after reposition by neutralization of the pathologic action of kinetic vectors on these fragments. Our goal in using this method is to stabilize the fractured fragments individually with consideration of soft tissues. Methods. In local (in the fracture) or Oberst analgesia, a correct size Alu-splint is placed over the wadprotected skin on the volar or dorsal side of the hand. The Alu-splint is fixed with Urgopore proximally and distally from the fracture. Then, correction using the reduction technique over the Alu-splinting is done. Such correction is followed by X-ray control and if the fragments are in good position, the construction is fixed with plaster One week later, X-ray control verifies the position of broken parts. Results. In the year 2000, 740 outpatients with a total of 779 (100%) metacarpal and phalangeal fractures were treated. There were 569 (73%) men and 210 (27%) women. The incidence in men was highest in the 10-19 years age group with 243 fractures. In the 50-59 years group, the incidence was equal in men and women (69 fractures). The highest prevalence of fracture slides was in the group of proximal phalanx fractures (190 fractures or 44%). X-ray control after one week showed 435 (56%) fracture slides in immobilization with plaster. (Abstract truncated at 2000 characters).
Summary		Izhodišča. Pri 779 zaprtih epifiznih, diafiznih, prečnih, poševnih, spiralnih, zdrob jenih prisklepnih in sklepnih zlomih kosti dlančnic in členkov prstov se je pokazalo v prvem tednu na kontrolnih rentgenskih slikah, da se je premaknilo veliko število zlomov, primarno zdravljenih z nebolečo naravnavo in učvrstitvijo z mavčevimi longetami. Da bi razrešili 435 premikov zlomov po primarni oskrbi z mavčevo longeto, smo se odločili za metodo ligamentotakso z aluminijasto opornico in povojem Softcast. Ta nam omogoča ob nepoškodovanem vezivnem skeletu, da obdržimo dober položaj po naravnavi premaknjenih odlomkov z nevtralizacijo patološkega delovanja kinetičnih vektorjev mišic z vezmi po daljši kostni osi ter pri strižnem in rotirajočem delovanju na odlomke. Cilj tega zdravljenja je stabilizacija odlomkov ob upoštevanju zaporedja varnega individualnega ravnanja z vezmi in kitami vsakega sklepa zlomljene kosti ter ob nastavitvi kotov po žarku kinetične verige sosednjih sklepov. Ti so glavni porok za biomehansko mirno dogajanje med kostnimi odlomki po resopbciji hematoma z edemom. Metode. V lokalni analgeziji ali analgeziji po Oberstu naravnamo zlom dolge kosti s prijemom metafiz A in B in jih raztegnemo po daljši kostni osi ter hkrati pritiskamo na izboklino diafize C. Potem povijemo del podlahta roke s prstom z vato. Izbrano aluminijasto opornico, zaščiteno z vato, namestimo volarno ali dorzalno glede na obliko zloma. Z povojem Urgopor pričvrstimo proksimalno in dorzalno od zloma prirejeno aluminijasto opornico. Nato sledi upogibanje aluminijaste opornice z nastavitvijo kotnih nagibov v sklepih in po žarku kinematične verige prstov. (Izvleček skrajšan na 2000 znakov).
Descriptors		WRIST INJURIES CARPAL BONES FINGER INJURIES METACARPOPHALANGEAL JOINT FRACTURE FIXATION TREATMENT OUTCOME