Crushing Hand Treated by One Stage Procedure Including Bone Fixation, Bone Graft, And Tendon Graft: Clinical Analysis of 14 Cases

Journal of the Korean Society for Surgery of the Hand 2003;8(2):90-94.
Published online June 1, 2003.

Jinrok Oh, Jungho Rah, Doosup Kim

골고정, 골이식 및 건이식을 포함하는 One Stage 술식을 통해 치료한 수부 압좌 손상: 14례 분석

오진록, 나중호, 김두섭

Abstract

Introduction: There are many obstacles to treat crushed hands coincidently involving nerves, vessels, tendons, and bone. The main influencing factors on the results of treatment include degree of circulation impairment, possibility of skin coverage and tendon repair, degree of bone defect. Usually crushed hands demand many times of operation or staged operation, and that is generally accepted. However, the more time it takes to treat it, the worse results are. So we tried to treat the patients by one stage procedure including firm fixation of bone with autogenous bone grafting, and tendon grafting. Then, we could early start physical therapy on injured hands in our cases. Materials and Methods: We treated total 26 crushed hands from May 1998 to June 2001. We selected 14 hands according to degree of circulation impairment and skin loss, possibility of stable fixation of bone fragments which didn’t involve joint, degree of tendon injury. In surgical procedures, we performed fixing bone fragments with plate and screws, repairing tendon or grafting tendon with harvested palmaris longus tendon, grafting autogenous bone harvested from distal radius or iliac bone, and suturing skin with or without repairing nerve. At postoperative first or second day, we encouraged active or passive motion of finger. Results: We used total active motion assessment system for finger fracture to evaluate the results. The results showed excellent in 4 cases(29%), good in 6 cases(43%), fair in 2 cases (14%), poor in 2 case(14%). There are complications in 4 cases, one wound infection, one rerupture of tendon, one reflex sympathetic dystrophy , one loosening of plate, respectively. Conclusions: Through our experience for crushed hands treated one-stagedm operation, in selective cases satisfying prerequisite conditions such as available skin coverage primarily, possible firm fixation of bone fragments, no joint involvement, and no circulation impairment, we think that one-staged procedure is available method to treat crushed hands.