Carpometacarpal Fracture-Dislocations: A Retrospective Review of Injury Characteristics and Radiographic Outcomes

Abstract

Background: The purpose of this study was to evaluate the demographics and early radiographic treatment outcome of patients with carpometacarpal (CMC) injuries at our institution over a 10-year period. Methods: We conducted a retrospective review of all patients who sustained CMC injuries of the second to fifth digits between 2005 and 2015. We recorded demographic data, mechanisms of and associated injuries, treatment methods, and complications. Injury and intraoperative and postoperative radiographs were evaluated, and the adequacy of reduction was determined on lateral radiographs of the hand using a grading system that we developed. Results: Eighty patients were included in this study. Delivering a blow with a closed fist was the most common mechanism of injury; however, high-energy mechanisms also made up a large percentage of those included. Injuries to the fourth and fifth CMC joints were most common, and these were frequently associated with fractures of the metacarpal bases and distal carpal row. Closed reduction and percutaneous pinning offered a higher percentage of patients with concentric reduction at the time of pin removal. Time to surgery was significantly different between those with concentric reduction and those with residual subluxation. Conclusion: The most common mechanism of CMC injuries was blow with a closed fist; however, these injuries can be associated with high-energy mechanisms. Fractures of the metacarpal base and distal carpal row are commonly seen with these injuries. With early diagnosis, closed reduction and percutaneous pinning achieved concentric radiographic reduction. Delayed diagnosis makes closed reduction difficult and was associated with less favorable radiographic outcome.

Open Reduction for Dorsal Dislocation of Second to Fifth Carpometacarpal Joints: A Case Report

“…6,8,12,17 In particular, open reduction is definitely needed when there are interposed tissues to be removed 8,18 or when closed reduction is unsuccessful in patients with subacute and chronic injuries. 4,19 In our case, the dislocation did not reduce because of the interposed displaced fourth metacarpal base fragments. Therefore, direct anatomical reduction of the fragment with open reduction was necessary.…”

“…Steinmetz et al reported that delay in diagnosis and treatment could lead to residual subluxation; therefore, precise diagnosis and treatment in the acute period allow for easier reduction. 4 Treatment for fracture-dislocations of ulnar CMC joints has been debated in the literature, and it has yet to obtain a consensus. When these injuries are diagnosed accurately and are acute injuries, some reports support conservative management.…”

Reconhecimento precoce e tratamento das fraturas e luxações carpometacarpais

“…Dorsal dislocations are more common than volar, since direct trauma tends to force the metacarpal in flexion. Steinmetz et al 1 found only one volar dislocation among 165 evaluated cases.…”

“…Steinmetz et al 1 described that among 81 injuries, 23 (28.8%) corresponded to the isolated injury in the CMC region of the 5 th , and 37 (45%) were due to the 4 th and 5 th injuries. In the same study, 87.5% of the cases corresponded to men, with the right hand being affected in 78.8% of the total.…”

“…Although it corresponds to < 1% of hand injuries, 1 it is not uncommon to doubt whether there is any radiographic alteration in the base of the carpometacarpal (CMC) from the second to the fifth fingers in the routine of attending orthopedic trauma. This is because there is a bone overlap between the CMC and the carpal bones, which may generate some misunderstanding in the interpretation of the images.…”