[Elastic stable intramedullary nailing of hand bones. ECMES even with the hand].
OBJECTIVE
Apply the principles of elastic intra-medullary nailing developed by Metaizeau for children, to bone fixation of bones of the hand.


METHODS
Retrospective review of 43 patients treated between 1995 and 1999 for fracture of one or more bones of the hand. Thirty five concerned the right hand, 11 the left; 54 involved metacarpal fractures and 2 fractures of the phalanx. Only those patients whose lesions were considered mended were taken into account in this study.


RESULTS
In 32 cases, bone fixation was completed with the use of a single pre-stressed pin, in 24 cases 2 prestressed pins forming a double arc were used. The delay in removal of material varied from between 35 days to 4 1/2 months. In three cases it required a dynamic splint treatment. Functional re-education was prescribed for two patients. Eight patients were lost for follow up. Fourty eight were followed with complete recovery of joint range of motion. We deplored one necrosis of the skin due to the contusion at the time of the initial trauma, one delayed healing after an animal bite required keeping the material in place for 4 months, one case of infection; in another case insufficient stabilization by the ECMES resulted in a 10 degrees mal-union of the metacarpal diaphysis. Three times the site of a fracture had to be opened in order to perform bone fixation.


CONCLUSIONS
The ECMES appears perfectly suitable for bone fixation of the diaphysis of bones of the hand and certain metaphyseal and epiphyseal fractures. Small incisions help to avoid unbecoming scars and adhesions and foster a rapid recovery of function.
Clinique ambulatoire, centre médical de Mamao BP 141008, 98701 Arue, Polynésie française. slallemand@cmm.pf
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Lallemand
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de Jesse Levas
D001858:Bone Nails; D002675:Child, Preschool; D005260:Female; D005593:Fracture Fixation, Internal / Q000379:methods*; D006230:Hand Injuries / Q000601:surgery*; D006801:Humans; D007223:Infant; D008297:Male; D008663:Metacarpus / Q000293:injuries / Q000601:surgery; D012189:Retrospective Studies; D016896:Treatment Outcome