Opening-wedge V-shaped corrective osteotomy for malunited fractures of metacarpal bones

Currently, the most commonly used method of treatment of patients with fractures of the metacarpal bones is closed reposition with immobilization of short-arm cast. This often leads to dislocation of fragments, their malunion, which leads to wrist functionality disorders and reduces the quality of patients' life. The main way to eliminate the deformities ‒ osteotomy of the metacarpal bones, followed by osteosynthesis. Purpose of the study ‒ to give a clinical assessment of the results of surgical treatment of patients with posttraumatic deformities of the Metacarpals, based on the use of a new method of corrective osteotomy. Methods. The proposed new method V-shape open angle of the osteotomy of the metacarpal bones whit malunion, followed by subsequent fixation of mini-plates (RF Patent for the invention No. 2651893 from February 20, 2017). The long-term results (in one year) of treatment of five operated patients with the consequences of closed fractures of the fourth and fifth metacarpal bones are presented. The state of the bone corn was studied by standard x-rays of the hand in two projections and by computed tomography. The angular deformity of the fragments was measured, the range of active movements in the metacarpophalangeal joints and the grip force were determined. Pain intensity was assessed by visual analogue scale, day-by-day activity-by DASH test, the results were divided into excellent, good, satisfactory and unsatisfactory by Buechler table. The frequency and nature of postoperative complications were also analyzed. Results. In all clinical cases, positive outcomes were obtained: angular deformity was corrected, the range of motion in the metacarpophalangeal joints and grip strength improved, and the functional parameters of the hand increased. In one clinical case stiffness was formed in the metacarpophalangeal joint, which required revision operation. Summary. Corrective V-shaped osteotomy of the metacarpal bones at the top of their deformation allows to restore the alignment of the fragments and prevent shortening of the bone. The use of stable osteosynthesis with low-profile mini-plates makes possible early functional management of patients, which prevents stiffness in the joints of the fingers.