Concurrent Dorsal Dislocations and Fracture-Dislocations of the Index, Long, Ring, and Small (Second to Fifth) Carpometacarpal Joints

OBJECTIVETo review the outcome of patients with concurrent dorsal dislocations and fracture-dislocations of the second, third, fourth, and fifth carpometacarpal (CMC) joints treated with open reduction and internal fixation (ORIF). DESIGNRetrospective review. SETTINGLevel 1 trauma center. PATIENTSBe...

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Veröffentlicht in:Journal of orthopaedic trauma 2001-11, Vol.15 (8), p.549-554
Hauptverfasser: Prokuski, Laura J, Eglseder, W Andrew
Format: Artikel
Sprache:eng
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Zusammenfassung:OBJECTIVETo review the outcome of patients with concurrent dorsal dislocations and fracture-dislocations of the second, third, fourth, and fifth carpometacarpal (CMC) joints treated with open reduction and internal fixation (ORIF). DESIGNRetrospective review. SETTINGLevel 1 trauma center. PATIENTSBetween 1991 and 1997, twelve multiply injured patients with the described CMC injury complex (one open injury) were treated with ORIF (eleven patients) or percutaneous wire fixation (one patient) by the same surgeon. INTERVENTIONTreatment consisted of ORIF with Kirschner wires followed by splints and immediate metacarpophalangeal and interphalangeal joint range of motion exercises. MAIN OUTCOME MEASUREMENTSGrip strength, wrist and finger range of motion, pain, need for additional surgery, and return to work. RESULTSOf the ten patients available for follow-up (mean, three years), all had been treated with ORIF (eight within forty-eight hours of injury and two had treatment delayed for four weeks because of delayed diagnosis and management of more serious injuries). Three patients had additional surgery (planned secondary second and third CMC arthrodeses). Grip strength of the operated hand in the five patients with JAMAR testing was 50 percent (n = 3), 75 percent (n = 1), and 90 percent (n = 1) of that in their contralateral hands. Five patients were pain-free, and five reported occasional, activity-related pain. The five patients who worked before the injury returned to their previous occupations (one with slightly modified duties). CONCLUSIONThis is the largest series of patients with this CMC injury complex and the first report of open CMC dorsal dislocations and fracture-dislocations. Although early ORIF is suggested, delay of up to four weeks did not adversely affect results.
ISSN:0890-5339
1531-2291
DOI:10.1097/00005131-200111000-00003