Anatomy and pathomechanics of ring and small finger carpometacarpal joint injuries

Yoshida, Ryo; Shah, Mansi; Patterson, Rita M.; Buford, William L.; Knighten, J.L.; Viegas, Steven F.

doi:10.1016/s0363-5023(03)00373-3

Cited by 72 publications

(52 citation statements)

References 15 publications

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“…In the current study, however, both the dorsal 4MC ulnar base-hamate-5MC radial base ligament and the dorsal 4MC ulnar base-hamate ligament that were identified would be removed by hamate harvesting. The hamate fracture fragment in fourth and fifth CMC joint fracture-dislocations resulting from a fist blow injury that Yoshida et al (2003) described is very similar to hamate harvesting. The fourth and fifth CMC joints would be less stable in the dorsal direction after hamate harvesting.…”

Section: Discussionmentioning

confidence: 84%

“…A small radial fragment remains in position due to the strong ligament attachments of the radial base of the fifth metacarpal to the fourth MC, while the rest of the fifth MC is displaced proximally by the pull of the ECU and the FCU via the 5MC-P segment of the p 3MC/4MC/5MC/HH-P ligament. Yoshida et al (2003) studied the pathomechanics and pathoanatomy of fracture-dislocations of the ring and small finger CMC joints and found a correlation between fracture sites and ligament attachment sites. This could explain the high incidence of a hamate fracture fragment in fourth and fifth CMC joint fracture-dislocations resulting from a fist blow injury (Yoshida et al, 2003).…”

Section: Discussionmentioning

confidence: 99%

“…Yoshida et al (2003) studied the pathomechanics and pathoanatomy of fracture-dislocations of the ring and small finger CMC joints and found a correlation between fracture sites and ligament attachment sites. This could explain the high incidence of a hamate fracture fragment in fourth and fifth CMC joint fracture-dislocations resulting from a fist blow injury (Yoshida et al, 2003).…”

Section: Discussionmentioning

confidence: 99%

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Three‐dimensional analysis of the ligamentous attachments of the second through fifth carpometacarpal joints

et al. 2006

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The purpose of this study is to clarify, measure, and show the anatomic locations and areas of specific ligamentous attachments and paths of the second through fifth carpometacarpal (CMC) joints on a three-dimensional (3D) surface model. Ten fresh-frozen cadaver wrists were used to dissect and identify the second through fifth CMC ligaments. Their ligamentous attachments and whole bone surfaces were digitized three-dimensionally and their areas calculated. The attachments of each ligament were represented in a model combining CT surfaces overlaid by a digitized 3D surface, and were also visually demonstrated with a specific color on 3D images of the bones. Nine dorsal and 11 palmar CMC ligaments and one CMC interosseous ligament were identified in the second through fifth CMC joints. An intra-articular ligament between the third metacarpal (MC), the fourth MC, capitate, and hamate was also identified. Five dorsal and five palmar intermetacarpal ligaments and three intermetacarpal interosseous ligaments were also identified in the second through fifth intermetacarpal joints. A previously undescribed palmar intermetacarpal ligament was located between the third, fourth, and fifth MC bases. The anatomic 3D attachment sites of the second through fifth CMC ligaments were visually depicted qualitatively, and their areas quantified. This 3D information will not only afford a better understanding of the anatomy and mechanics of the second through fifth CMC joints, but will also assist in the assessment of radiographic images and treatment of various injuries.

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Section: Discussionmentioning

confidence: 84%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Three‐dimensional analysis of the ligamentous attachments of the second through fifth carpometacarpal joints

et al. 2006

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“…The strong ligamentous structures and intricate alignment of the carpal bones readily resist dislocation (1,2). There are numerous case reports and small retrospective studies (3)(4)(5)(6) evaluating the treatment and outcome of concurrent CMC fracture dislocations.…”

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confidence: 99%

Postoperative management of carpometacarpal joint fracture dislocation of the hand: A case report

Bell¹,

Chinchalkar²

2010

J Plast Surg

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M ultiple fracture dislocations of the carpometacarpal (CMC) joints are rare injuries. The strong ligamentous structures and intricate alignment of the carpal bones readily resist dislocation (1,2). There are numerous case reports and small retrospective studies (3-6) evaluating the treatment and outcome of concurrent CMC fracture dislocations.Prokuski and Eglseder (7) produced the largest series of multiple CMC fracture dislocations to date. In their retrospective review at a busy trauma centre, they reported 10 cases of concurrent fracture dislocations of the index through small CMC joints over a six-year period. The majority of these were caused by motor vehicle collisions. Their outcome variables assessed postoperative pain, grip strength, range of motion (ROM) and return to work. Pain responses were available for all 10 patients. Five of the patients were pain free at the time of final follow-up. The remaining patients had mild activityrelated pain, controlled with activity modification. Strength testing was available for five patients. Grip strength testing at six months postoperatively ranged from 50% to 90% of the contralateral limb. Testing revealed full ROM in six patients. The remaining four patients had decreased ROM that was not functionally disabling. Three of the 10 individuals required additional surgery; all required late arthrodesis. Finally, five of the patients were able to return to their preinjury occupations. The authors concluded that early open reduction and internal fixation offered adequate functional outcomes. Other studies (8) have noted similar operative outcomes.Multiple CMC dislocations are uncommon and, to the best of our knowledge, there are no large studies that have examined postoperative rehabilitation for this injury. A recent review by Feehan (9) emphasized the importance of early controlled mobilization for reducing postinjury complications of the hand. Common complications that result because of prolonged immobilization include stiffness of hand joints, tendon adhesions and muscle weakness (10). Dowden (10) emphasized that early controlled motion must be balanced with sufficient immobilization at areas of injury (ie, fractures and dislocations) to ensure that adequate healing occurs.The purpose of the present study is to describe a novel postoperative rehabilitation regimen in a multiple CMC fracture dislocation patient. In particular, we emphasize the need for early, protected ROM activity and the use of a carpal stabilization splint to achieve adequate hand function. Case presentationA 28-year-old left hand-dominant man sustained an isolated multiple CMC fracture dislocation injury following a motor vehicle collision (Figure 1). Satisfactory closed reduction was not attainable (Figure 2), and open reduction and internal fixation with Kirscher wires was performed through a dorsal transverse incision (Figure 3). The wrist and hand were immobilized in the neutral position for two weeks in a short arm splint and for an additional four weeks in a short arm circumferential ca...

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“…Generally, these dislocations are fracture dislocations due to avulsion of the ligaments. The size of the fracture fragments depends on the position, direction, and transmission of the trauma forces through the metacarpals (MC) [16].…”

Section: Discussionmentioning

confidence: 99%

Acute Ulnar Carpometacarpal Dislocations. Can it be Treated Conservatively? A Review of Four Cases

Storken

Bogie

Jansen

2011

Hand (New York, N,Y.)

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Anatomy and pathomechanics of ring and small finger carpometacarpal joint injuries

Cited by 72 publications

References 15 publications

Three‐dimensional analysis of the ligamentous attachments of the second through fifth carpometacarpal joints

Three‐dimensional analysis of the ligamentous attachments of the second through fifth carpometacarpal joints

Postoperative management of carpometacarpal joint fracture dislocation of the hand: A case report

Acute Ulnar Carpometacarpal Dislocations. Can it be Treated Conservatively? A Review of Four Cases

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