![]() The authors noted that simple treatment according to Iselin's technique still has many indications despite progress in miniaturized osteosynthesis. Articular lesions constituted a factor of severity and failure to respect opening of the commissure appeared to be more pejorative than a small imperfection of reduction. A 100-point grading system was established and, independent of the type of treatment, the authors obtained 61% of very good results, 23% of good results, 12% of moderate results, 2% of poor results and 2% of very poor results. A number of clinical and radiological criteria were studied in the 88 patients reviewed. Figure 1: The 5 metacarpal bones are shown in red. From radial to ulnar, the bones are numbered one (thumb) through five (small finger) and consist of a shaft, base, and head. 11 fractures with minimal displacement had been immobilised in a plaster cast without reduction. Structure and Function The metacarpals consist of five tubular bones that articulate proximally with the carpus and distally with the phalanges (Figure 1). In this series, 35% of cases were treated orthopedically, 57% according to Iselin's technique, 5% by direct osteosynthesis and 3% by external fixation with a mean immobilization of 40 days. The treatment of 64 intra-articular fractures at the base of the fifth metacarpal was studied. 12% of fractures were open and 45% were associated with other traumatic lesions. ![]() 70% of patients were younger than 40 and in one half of cases the causal accident was a motor vehicle accident. They used a classification into 5 types (Bennett's with a large fragment = 22%, Bennett's with a small fragment = 20%, Rolando = 15%, extraarticular fractures = 36%, Comminuted fractures = 6%) which are easy to recognize on standard x-rays, or preferably on Kapandji views, allowing a standardized therapeutic approach. The authors have analysed the clinical and radiological results of a series of 138 recent fractures of the base of the first metacarpal with a mean follow-up of 7 years (12 month-14 years). Fractures on the base of the first metacarpal are uncommon lesions, affecting young subjects and have major social repercussions (an average of 3.5 months off work).
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