Carpometacarpal 4/5 Fracture Dislocations: Fracture Morphology and Surgical Treatment

Abstract

We conducted a retrospective review of six patients with carpometacarpal (CMC) ⅘ fracture-dislocations managed with ORIF by a single surgeon between October 2006 and August 2017. An open, dorsal approach to the hamate was used with a combination of interfragmentary screw fixation and Kirschner wire reduction in the CMC joints. At a mean of 96 days follow-up (range: 31–265), all patients had recovered wrist motion, excellent grip strength, and complete resolution of pain. There were no complications or reoperations during the postoperative period. Radiographic review showed restoration of anatomy and well-maintained congruity of the CMC joints. Our study has shown favorable outcomes after open reduction and internal fixation of the hamate body fracture with interfragmentary screws, when combined with stabilization of the CMC dislocation with percutaneous Kirschner wires. Fracture morphology does not appear to guide choice for specific hardware (size screw, headed/headless) or use of a washer. This is a level IV, therapeutic study.

Luxofractura Hamate Metacarpiana. Presentación de 4 Casos y Revisión de la Literatura

“…5 Las luxofracturas hamate metacarpianas abarcan un espectro de lesiones complejas raras, con una incidencia de 0,2% a 1% del trauma de mano. [4][5][6][7][8] De forma similar, las fracturas del hamate son el 2% de las fracturas del carpo. 9,10 La coexistencia de ambas lesiones es más rara aun, representando el 10 a 15% de las luxofracturas de la región carpometacarpiana.…”

“…1 These factors delay the resolution of such injuries, leading to worse outcomes regarding pain and functionality.. 5 Hamate metacarpal dislocations encompass a spectrum of rare complex injuries, with an incidence of 0.2% to 1% of hand trauma. [4][5][6][7][8] Similarly, hamate fractures account for 2% of carpal fractures. 9,10 The coexistence of both injuries is even rarer, representing 10 to 15% of dislocated carpometacarpal fractures.…”