Computerized tomographic prediction of flexor tendon injuries complicating hamate hook fractures

Clinical application of ultrasound-guided selective proximal and distal brachial plexus block in rapid rehabilitation surgery for hand trauma

BACKGROUND

Anesthesia plays an essential role in the successful surgical procedures for hand trauma. Compared with general anesthesia, brachial plexus block shows lots of benefits for the upper extremity. Specifically, ultrasound-guided selective proximal and distal brachial plexus block may overcome the issues of incomplete block and failure of anesthesia in such circumstances. The present study assessed the efficacy of ultrasound-guided selective proximal and distal brachial plexus block in clinical practice.

AIM

To explore the efficacy of ultrasound-guided selective proximal and distal brachial plexus block in rapid recovery surgery for hand trauma.

METHODS

A total of 68 patients with traumatic hand injuries treated at our hospital from January 2018 to June 2019 were selected. They were divided into an observation group and a control group with 34 patients in each group. The observation group underwent selective brachial plexus block guided by ultrasound and the control group underwent conventional brachial plexus block. The analgesic efficacy, intraoperative complications, wound healing time, and length of hospital stay were compared between the two groups under different anesthesia.

RESULTS

The percentage of cases with analgesia graded as “excellent or very good” was higher in the observation group than in the control group (P < 0.05). Moreover, the incidence of intraoperative complications was lower and the wound healing time and length of hospital stay were shorter in the observation group than in the control group (P < 0.05).

CONCLUSION

Ultrasound-guided selective proximal and distal brachial plexus block has remarkable analgesic efficacy in patients with traumatic hand injuries. It can reduce the incidence of intraoperative complications, promote wound healing, and shorten the length of hospital stay.

Features of intra-hamate vascularity and its possible relationship with avascular risk of hamate fracture

BACKGROUND

The angiography with micro-computed tomography (micro-CT) has been proved its great advantages on investigating the intra-osseous vascularity of carpal bones. But few researches have focused on the intra-hamate vascularity. This study aimed to illustrate the intra-osseous arteries of the hamate and the relationship between the intra-hamate vascularity and the avascular risk of different types of hamate fractures.

METHODS

Six normal cadaveric hamates were investigated with red lead (Pb3O4) micro-CT angiography. The intra-osseous arteries of specimens were clearly enhanced and the three-dimensional model was reconstructed. In order to study the features of the arterial entrances and intra-hamate vascularity, the diameters, quantities, locations of enhanced arteries, and the locations of transversal/proximal pole fracture lines on the body of the hamate were statistically compared. Besides, in order to analyze the relationship between intra-hamate vascularities and different hamate fractures, 127 cases of hamate fractures who presented in our hospital from March 2003 to June 2017 were retrospectively studied.

RESULTS

A total of 94 cases were followed up (range: 4-37 months; mean: 12.4 months) effectively. The overall union rate of hamate fractures was as high as 92.6% (87 of 94 cases), while non-union of fracture on hamate hook was more common (P = 0.031). The arterial entrances were located around the dorsal, volar, radial, ulnar non-articular surfaces of the hamate body and the hook of the hamate. Generally, there were one to two trunk arteries on the volar non-articular surface and one to three trunk arteries on the dorsal non-articular surface. They formed one or two arterial arches, from which some branches were emitted and supplied the proximal parts. The intra-osseous vascularities of the hamate body were generally located in the radial part. The blood supply of the hook was mainly from the volar non-articular surface in most specimens. Hamate fractures could be classified into four types: fractures of the transversal/proximal pole, medial tuberosity, dorsal coronal of the hamate body, and fractures of the hamate hook.

CONCLUSIONS

This study showed new features of intra-hamate vascularity and the results will guide surgeons to reduce the vascular damage during the hamate fracture operations. The fracture lines of different types of hamate fractures may disrupt the intra-hamate arteries. The intra-hamate vascularities will have different influences on the avascular risks of different hamate fractures.