手指末節骨骨幹部骨折および偽関節に対する指尖部よりのHerbert mini bone screwの刺入

Osteosynthesis with Herbert Mini Bone Screw in Fractures and Nonunions of the Distal Phalanx of the Finger

　末節骨骨折および偽関節に対してHerbert mini bone screwを用いて治療を行い良好な結果が得られたので報告する．症例は不安定性の強い末節骨骨幹部骨折2例，2指および末節骨偽関節1例，2指の3例，4指である．指ブロック下に指尖部に小切開を加え，C-wireを刺入して回旋を防止した後，骨折部を展開せずに透視下にHerbert mini bone screwを逆行性に刺入した．骨癒合は全指で得られた．末節骨骨折の遷延治癒発生率は約15～25％と比較的高い頻度であるとされている．骨折部が不安定な場合は，指尖部からのHerbert mini bone screwの刺入は治療法の選択肢の1つとなり得る．

　Four fingers in 3 patients with unstable fracture or pseudoarthrosis of the shaft of the distal phalanx were operated on with percutaneous insertion of the Herbert mini bone screw. There were 2 males and 1 female. A 42-year-old female sustained an unstable fracture in the left ring finger, a 56-year-old male an unstable fracture in the left little finger and a 35-year-old male had pseudoarthrosis in left index and middle fingers. The Herbert mini bone screws were inserted percutaneously in a retrograde manner with no bone grafting under digital nerve block. Solid bony fusion was obtained in all fingers within 1 to 4 months (average 2.7 months) postoperatively. The Herbert mini bone screw is useful in osteosynthesis of unstable fractures or pseudoarthrosis of the distal phalanx, because the screw can get good stability of the fracture site and allows early range-of-motion exercise of the affected fingers.