First metacarpal base (Bennett) fracture-dislocation open reduction

Applicable to the first metacarpal base fracture-dislocation. Treatment of diseases: the first metacarpal base fracture and dislocation of the first metacarpal base fracture Indication The first metacarpal base fracture (Bennett fracture) dislocation, unsatisfactory after manual reduction and external fixation, or old fracture dislocation. Contraindications Brachial anesthesia. Preoperative preparation 1. The fracture is caused by severe trauma. The patient has severe pain and blood loss. Analgesic and blood matching should be given before surgery. For patients with poor general condition or existing shock, anti-shock treatment such as infusion and blood transfusion should be given, and the operation should be performed after the condition is stable. 2. Preoperative fracture sites should be taken with positive lateral radiographs to determine the location, shape and displacement of the fracture, which is convenient for determining the surgical procedure and internal fixation. For those who need to take X-rays during surgery, they should inform the radiology department and the operating room in advance to prepare. 3. The surgeon should propose the special equipment to be used and check whether the preparation of the equipment is complete, so as to avoid temporary preparation and prolong the operation time. 4. Open fractures should be treated with antibiotics and tetanus antitoxins; or if the original open fractures were delayed for more than 2 weeks, antibiotics and repeated injections of tetanus antitoxin should be used. 5. After the reduction and reduction, the internal fixation or bone graft should be used. The antibiotic should be intravenously administered immediately after anesthesia, and once every 6 hours, share 4 times. 6. The fracture site should have sufficient range of cleaning and disinfection preparations. The surgeon should avoid contact with the suppurative wound on the same day, and strictly follow the hand washing procedure to prevent the wound infection. 7. Patients who need to delay surgery for the first time should be towed first, can be reset, temporarily fixed, and can overcome soft tissue contracture, reducing the difficulty of resetting during surgery. 8. Need to simultaneously bone fractures, such as delayed bone fractures, slow healing fractures, etc., should be prepared for the bone area after surgery. Surgical procedure Bennett fracture-dislocation, closed reduction is easy, but it is very difficult to maintain a reduction to fracture healing. Therefore, if conditions permit, the use of percutaneous needle internal fixation open reduction and internal fixation should be used. Open reduction is not only suitable for fresh cases, but also for one month after injury. Most of the internal fixations are K-wires, and those with compression screws are also available. The X-ray film showed that the flank bone was small, and there were joint capsules and ligaments attached to the in situ; the dorsal bones were large, and the abductor hallucis, the flexor hallucis longus and the adductor muscles were combined to the back. Lateral dislocation. On the dorsal side of the first metacarpal 1/2, an "L" shaped incision was made along the outer edge and the proximal edge of the large intermuscular muscle. Be careful not to damage the superficial branch of the sacral nerve to the temporal branch of the thumb. The thumb abductor muscle, the thumb-palm muscle and the first metacarpal bone were separated, and the first carpometacarpal joint capsule was revealed. Cut some of the joint capsules, clear the blood clots, and the fracture ends are clearly visible. The assistant holds the thumb and forearm of the patient for pulling and rotating, and the surgeon clamps the back fracture of the palm with a towel clamp to temporarily maintain the reset. The dorsal fracture block was first fixed to the majority of the bone with a Kirschner wire (less than 1 mm in diameter). A Kirschner wire was used to percutaneously penetrate the dorsal fracture of the palmar side. After the fracture was restored and fixed, the joint capsule and skin incision were sutured. Brake the thumb to the palm of your hand with a U plaster holder. After 6 weeks, the plaster was removed, the steel needle was removed, and the protective activity began, and the functional exercise was gradually increased. complication Can be complicated by median nerve injury and flexor tendon rupture.