单纯钩骨钩骨折致尺神经深支损伤的临床研究

目的探讨单纯钩骨钩骨折致尺神经深支损伤的致病机理。方法采用16侧甲醛固定和4侧新鲜成人尸体标本。以钩骨钩中点为O,过O点作一条水平线及垂线,水平线与尺神经深支的交点为A点,与钩骨钩基底尺侧交点为B点,垂线与尺神经的交点为C点,分别测量OA、OB、OC、AB长度,并进行统计学分析;对1996年4月~2009年6月5例单纯钩骨钩骨折合并尺神经深支损伤进行回顾分析。结果尺神经深支绕过钩骨钩的基底部进入掌深间隙,OA的长度为(4.96±0.11)mm、OB的长度(3.69±0.12)mm、OC的长度(10.55±1.07)mm、AB的长度为(1.27±0.15)mm;5例根据中华医学会手外科学会上肢周围神经功能评定试用标准:优4例,良1例。结论单纯钩骨钩骨折可致尺神经深支损伤但临床容易漏诊,早期正确诊治是神经功能得以恢复的关键。     

Closed rupture of the flexor tendons of the little finger secondary to non-union of fractures of the hook of the hamate

We report six patients with closed flexor tendon rupture affecting the little finger, occurring secondarily to non-union of the hook of the hamate bone. The ununited fragments were separated from the basal part of the hook by more than 1mm. The fragments were also rounded and showed marginal sclerosis. Non-union was located in the middle part of the hook in three patients, the tip in two, and the base in one. At operation, the fragments were removed in all patients. Five patients were treated by free tendon grafts using three palmaris and two plantaris grafts and one underwent tendon transfer. Postoperative total range of active motion of the little finger averaged 218 degrees (range 185-265 degrees ). All patients returned to their original employment. This series would suggest that flexor tendon rupture can occur after fracture of the hook of the hamate bone, even when the ununited fragment is small and/or rounded.     

Cadaveric study comparing the stability of upper distraction hooks used in Harrington instrumentation

Many different designs of upper distraction hooks for use in Harrington instrumentation are available. There is no published evidence to date to support the use of one hook in preference to another. This study compares the distraction force required to dislodge the three most commonly used designs of Harrington upper distraction hook. In cadavers the force required for failure of the plain, ribbed, and bifid hooks was compared as were the modest of vertebral fracture at the time of cut out. The bifid hook required a significantly greater distraction force to fracture the lamina, and the pattern of fracture was more extensive than it was with the plain or ribbed hooks.     

Lateral approach to the hook of hamate for its fracture

We have recently experienced one case of the fracture of the hook of the hamate that was diagnosed only by the CT scan. As a surgical approach, lateral approach to the hook of the hamate for its fracture was utilized. We found that this approach was safe, easy and quick.     

Evaluation of grip strength in hook of hamate fractures treated with osteosynthesis. Is this surgical treatment necessary?

ObjectiveThe aim of this study was to evaluate the outcomes of open reduction and internal fixation (ORIF) in hamate hook fractures and review the literature on this surgical procedure.MethodsWe report the outcomes of ORIF of hamate hook fractures in 13 consecutive patients (12 men and 1 woman; mean age: 32 years (range, 22–48 years)). In eight patients (61%) the fracture was associated with ulnar nerve neuritis in Guyon's canal. We assessed the following clinical data: age, sex, mechanism of injury, side of the injured hand and associated lesions, fracture classification, average time from injury to correct diagnosis, surgical technique, complications, and length of follow-up.All patients underwent radiological imaging, including standard radiographs in two planes (anteroposterior and lateral projections), and a CT study. Functional outcomes evaluated were pain, range of motion, grip strength, Disabilities of the arm, shoulder and hand (DASH) and Mayo wrist score.ResultsThe mean follow-up was 36 months (range, 12–144 months). All 13 cases were treated with ORIF of the hook of the hamate. Mean VAS pain score was 5 preoperatively (4–9) and 1 (0–2) postoperatively. All patients returned to pre-injury level and only one patient felt pain on activity. Preoperative modified Mayo wrist score was 51 and the postoperative value was 94. All outcomes scores improved significantly from preoperative values. The patients who participated in sports postoperatively were able to do so at or near pre-injury levels. Postoperative average range of wrist motion was 76° in extension, 71° in flexion, 14° in ulnar deviation, and 21° in radial deviation.Mean grip strength in the hand with the hook fracture was 58 kg compared with 53 Kg in the unaffected hand. All patients returned to their pre-injury level of functioning after 10–12 weeks and there were no complications. Analysis of grip strength revealed values comparable with the unaffected hand.ConclusionORIF of hamate hook fractures is a safe and effective technique to restore normal grip strength and return to pre-injury level. In cases of ulnar nerve neuritis, neurolysis of the deep palmar branch is mandatory.Level of evidenceLevel IV, Therapeutic study.     

钩骨钩部骨折四例报告及文献复习

目的 临床上钩骨钩部骨折比较罕见而常被误诊，故阐明其症状、影像学检查特点及手术疗效。方法 对4例钩骨钩部骨折病史进行分析及文献复习。钩骨钩部骨折临床表现为腕部尺侧局限性压痛，腕部力量减弱。4例的腕部正侧位X线片未能确诊而CT影像学表现则确诊为钩骨钩部骨折。4例均作切开复位、螺钉内固定术和腕尺管切开术，其中1例同时作腕管切开术。结果 术后随访5-12个月，骨折均已愈合．症状消失。结论 钩骨钩部骨折白勺发病率低，易漏诊．是罕见而易被误诊的骨折。CT检查是最好的诊断手段。     

Inferior turbinate fracture in the treatment of congenital nasolacrimal duct obstruction and congenital nasolacrimal duct anomaly

A group of 52 pediatric patients with lacrimal obstruction were considered to be high risk since they had been previously probed (27 patients) or were older (average age 23 months). At the time of probe and irrigation, a small, straight hemostat was placed into the nose to grasp the inferior turbinate and rotate it a full 90 degrees inward. All cases of congenital nasolacrimal duct obstruction (49) resolved following this maneuver. A small muscle hook with the tip directed upward was placed underneath the inferior turbinate to identify three patients with congenital nasolacrimal duct anomaly (absence or atresia of the nasolacrimal duct) who would not have benefitted from further probings and responded to dacryocystorhinostomy. Even though the results of our uncontrolled surgical trial cannot be compared to other treatment methods, the data suggest that even very difficult cases of congenital nasolacrimal duct obstruction will respond to a simple turbinate fracture with a hemostat without the necessity of complicated tubes or stents. A small muscle hook can be used to identify those rare cases of congenital nasolacrimal duct anomaly who may require specialized procedures such as dacryocystorhinostomy or inferior turbinectomy.     

Transverse carpal ligament disruption associated with simultaneous fractures of the trapezium, trapezial ridge, and hook of hamate: a case report

Traumatic disruption of the transverse carpal ligament associated with fractures of the trapezial ridge and hook of hamate is a known entity. Only one report of a coronal fracture of the trapezium has been mentioned in the literature. We report a combination of these two injury patterns. Diagnosis was aided by computed tomography. Treatment involved excision of the trapezial ridge and hook of hamate fragments with lag screw fixation of the trapezial body fracture.     

Fractures of the calcaneum: a study of the long-term prognosis

Two hundred and three consecutive fractures of the calcaneum occurring in 185 patients between 1961 and 1968 have been reviewed. These patients were treated by essentially non-operative methods. The study revealed that fracture of the calcaneum is a relatively common injury, after which persisting symptoms are frequent. Symptoms present two years after injury showed little tendency to improve. The duration of absence from work was often lengthy. The prognosis after this fracture is better if the fracture does not involve the posterior talocalcaneal joint. The usual radiographs taken to investigate a suspected calcaneal fracture seldom provide adequate information about the congruity of that joint, and oblique views are recommended.The results of non-operative treatment, though no worse than reported results of operative intervention, are not good enough and demand further studies on this subject.     

Hook of the hamate fractures in competitive golfers: results of treatment by excision of the fractured hook of the hamate

Seven competitive golfers presented with isolated fractures of the hook of the hamate. All patients were treated with excision of the fractured hook of the hamate, with complete resolution of pain. All patients returned to their previous level of play. It is reasonable to deduce, with this group of patients, that this fracture pattern represents an overuse or repetitive motion injury. Regardless of etiology, prompt diagnosis and treatment of this injury with excision of the fractured hook of the hamate bone allows competitive golfers to return to their previous level of competition.     

Fracture-separation of the distal humeral epiphysis. Long-term follow-up of five cases

Fracture-separation of the distal humeral epiphysis is a rare injury described in young children. The diagnosis is often difficult because most of the ossification centre are not visible. We report a long-term follow-up study of five cases, evaluated after an average of 38 years. At the time of fracture, all the patients were more than 3 years old. Three patients had been treated with overhead traction, closed reduction and immobilisation in a long-arm plaster cast, one patient with closed reduction and immobilisation and another one, initially not diagnosed, had been treated after 2 weeks with only immobilisation in a long-arm plaster cast. Cubitus varus deformity was observed in one of the five patients. In the remaining four cases the cubitus was less valgus than the opposite side. No patient complained of any functional disability even though in two of them, one treated late and another one who had an inadequate reduction, radiographic signs of degenerative arthritis were present. We believe that the amount of displacement of the fragments, the quality of the reduction and the age at the time of fracture are important factors influencing the development of cubitus varus deformity.     

Biomechanical Analysis of Implanted Clavicle Hook Plates With Different Implant Depths and Materials in the Acromioclavicular Joint: A Finite Element Analysis Study

Clinical implantation of clavicle hook plates is often used as a treatment for acromioclavicular joint dislocation. However, it is not uncommon to find patients that have developed acromion osteolysis or had peri‐implant fracture after hook plate fixation. With the aim of preventing complications or fixation failure caused by implantation of inappropriate clavicle hook plates, the present study investigated the biomechanics of clavicle hook plates made of different materials and with different hook depths in treating acromioclavicular joint dislocation, using finite element analysis (FEA). This study established four parts using computer models: the clavicle, acromion, clavicle hook plate, and screws, and these established models were used for FEA. Moreover, implantations of clavicle hook plates made of different materials (stainless steel and titanium alloy) and with different depths (12, 15, and 18 mm) in patients with acromioclavicular joint dislocation were simulated in the biomechanical analysis. The results indicate that deeper implantation of the clavicle hook plate reduces stress on the clavicle, and also reduces the force applied to the acromion by the clavicle hook plate. Even though a clavicle hook plate made of titanium alloy (a material with a lower Young's modulus) reduces the force applied to the acromion by the clavicle hook plate, slightly higher stress on the clavicle may occur. The results obtained in this study provide a better reference for orthopedic surgeons in choosing different clavicle hook plates for surgery.     

肩锁关节脱位和锁骨远端骨折两种固定方法的比较

目的比较采用插入式锁骨钩钢板与克氏针加张力带钢丝内固定治疗肩锁关节脱位和锁骨远端骨折的临床疗效。方法回顾分析我院1997～2005年采用克氏针加张力带钢丝固定治疗的91例肩锁关节脱位和锁骨远端骨折及2002-2007年采用插入式锁骨钩钢板固定治疗的57例肩锁关节脱位和锁骨远端骨折。复位骨折或脱位后，前者用1～2枚直径为2．0或2．5mm克氏针由外向内经肩峰穿入锁骨外1／3附近上方出针，加用张力带钢丝加强固定；后者先将锁骨钩钢板的钩部插入肩峰下，然后将钢板体部用螺钉固定于锁骨上。结果前者91例患者中80例获得12～18个月随访，74例患者正常愈合，6例患者出现克氏针松动退出，导致固定失败二次手术。后者57例患者中51例获得12～20个月随访，51例患者全部正常愈合，无一例固定失败。结论采用插入式锁骨钩钢板固定治疗肩锁关节脱位和锁骨远端骨折操作简单、固定可靠、成功率高，符合生物力学要求，术后功能康复快，明显优于克氏针加张力带钢丝固定。     

Failure of knee osteotomy in a case of neuropathic arthropathy of the knee

Neuropathic arthropathy (Charcot’s joint) is a degenerative process that affects peripheral or vertebral joints as a consequence of a disturbance in proprioception and pain perception. The knee is one of the most frequently affected joints, but even when the diagnosis is made at an early stage there is no consensus on the best treatment options. An early diagnosis of neurosyphilis was made in a 55-year-old woman presenting a delayed union of an asymptomatic Schatzker type IV fracture of the proximal tibia. A medial opening wedge tibial osteotomy was performed to achieve fracture healing, to correct the medial depression of the articular surface, and possibly to avoid an early arthritis typical of the disease. To our knowledge, a knee osteotomy has never been reported at an early stage of neuropathic arthropathy. Even though the clinical and radiographic evaluation performed at 4 months follow-up showed a good stage of healing of the osteotomy and no typical features of neuropathic joint degeneration, at 8 months follow-up the knee was markedly deranged.     

Rupture of the flexor digitorum profundus tendon to the small finger within the carpal tunnel.

We report three patients who sustained a rupture of the flexor digitorum profundus tendon to the small finger within the carpal tunnel. There was a common mechanism of injury, each rupture occurred during resisted flexion of the digit with the metacarpophalangeal joint in extension. All the patients were male, one patient had an asymptomatic undiagnosed fracture of the hook of hamate, one patient had radiological evidence of piso-triquetral osteoarthritis. In each case, an attrition rupture was confirmed at surgery.     

Hook of hamate vascularity: Vulnerability to osteonecrosis and nonunion

A clinical impression of avascular changes in the hook of the hamate after fracture led to this study of the pattern and size of the hamate hook vascular foramina. It appears that vessels enter the hamate hook at primarily two sites. The radial base foramina are large and always present, while the ulnar tip foramina are small and absent in 29% of specimens. In these hamates, fracture at the hook base could potentially compromise blood supply to the hook fragment, and this may be a factor in hamate hook nonunion.     

钩钢板治疗Neer II型锁骨骨折术后锁骨中段骨折的危险因素分析

目的分析钩钢板治疗Neer II型锁骨骨折术后锁骨中段骨折的潜在危险因素。 方法在2009年3月至2019年7月期间,有294例患者使用了钩钢板治疗锁骨远端骨折并符合入选标准,其中279例术后未发生锁骨中段骨折的患者（对照组）、15例发生了术后锁骨中段骨折的患者（并发症组）。本研究收集了患者的数据,包括性别、年龄、骨折患侧、体重指数、吸烟情况、最内侧螺钉的种类、是否由住院医师作为术者进行手术、术中钩钢板是否进行了塑型、钢板的孔数、钩的深度、并发症的发生时间和发生时有无第二次创伤。本研究采用卡方检验对所有潜在的危险因素在对照组和并发症组间进行了比较。最后对具有统计学差异的变量进行了Logistic回归分析。 结果高龄患者在使用钩钢板治疗锁骨远端骨折后,更容易出现锁骨中段骨折（OR= 3.478; 95% CI : 1.719~15.407; P= 0.003）。 结论患者高龄可以显著增加钩钢板固定后锁骨中段骨折的发生率。     

Finger tendon rupture secondary to fracture of the hamate. A case report

Rupture of the flexor tendon of a finger secondary to fracture of the hook of the hamate is extremely rare; only seven previous cases have been published. We report an additional case and discuss the functional anatomy, diagnosis and treatment.     

Flexor tendon ruptures secondary to hamate hook fractures

Four patients with flexor tendon ruptures secondary to hook of the hamate fracture are described. None of the patients had the diagnosis of fracture made before tendon rupture. All patients were treated with excision of the fractured hook and tendon repair. The tendon repair was usually an end-to-side (Y junction) of the profundus of the small to the profundus of the ring finger. After operation, all patients were free of pain and returned to their preinjury activity levels, but most had some limitation of motion in the digit with the tendon repair. The complication of tendon rupture not uncommonly follows basilar hook of the hamate fractures. Treatment by excision of the fracture and end-to-side tendon repair produces satisfactory results. Range of motion after tendon repair seems to depend more on the patient's age and the amount of inflammation at the site of repair rather than on the method of tendon repair.     

Surgical treatment of unstable fractures of the distal clavicle: A comparative study of Kirschner wire and clavicular hook plate fixation

During 1988-1999 39 unstable fractures of the distal clavicle (Neer 2) were operated on in Oulu University Hospital. Kirschner wire (K-wire) fixation was used in 22 cases and a clavicular hook plate in 17. Shoulder symptoms and function were assessed using self-administered questionnaires devised by L'Insalata et al. (1997), and Constant scoring. Mean follow-up was 6.2 years in the K-wire fixation group and 2.0 years in the clavicular hook plate one. The mean L'Insalata scores were 91 in both groups (92% and 93% of the contralateral side) and the mean Constant scores 84 (95%) and 90 (96%) for K-wire fixation and the clavicular hook plate, respectively. Complications commonly occurred with K-wires, which migrated in 12 cases, resulting in loss of reduction in 7 and infection in 3, and 2 cases of non-union. In the clavicular hook plate group, there was 1 complication, a fracture of the clavicle, and 2 cases of non-union. We conclude that shoulder symptoms were reduced and function restored to an adequate level by both methods, but complications were unacceptably frequent when K-wires were used. The clavicular hook plate was better in this respect and it is therefore recommended.