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J Hand Microsurg 2020; 12(S 01): S21-S27
DOI: 10.1055/s-0039-1692326
Original Article

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

Svenna H. W. L. Verhiel
1   Department of Orthopaedic Surgery, Hand and Upper Extremity Service, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States
,
William J. Knaus
1   Department of Orthopaedic Surgery, Hand and Upper Extremity Service, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States
,
Frank J. Simeone
2   Department of Radiology, Musculoskeletal Imaging and Intervention, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States
,
Chaitanya S. Mudgal
1   Department of Orthopaedic Surgery, Hand and Upper Extremity Service, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States
› Author Affiliations Funding None.
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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.

Keywords

carpometacarpal fracture-dislocation - fracture morphology - hamate fracture - surgical technique


Publication History

Article published online:
26 June 2019

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  • References

  • 1 Kerr HD. Hamate-metacarpal fracture dislocation. J Emerg Med 1992; 10 (05) 565-568
    CrossrefPubMedGoogle Scholar
  • 2 Austin RE, Pennings AL, ElMaraghy AW. Intraosseous fifth carpometacarpal dislocation associated with a coronal hamate fracture: a case report. JBJS Case Connect 2014; 4 (03) e76-e4
    CrossrefPubMedGoogle Scholar
  • 3 Cano Gala C, Pescador Hernández D, Rendón Díaz DA, López Olmedo J, Blanco Blanco J. Fracture of the body of hamate associated with a fracture of the base of fourth metacarpal: a case report and review of literature of the last 20 years. Int J Surg Case Rep 2013; 4 (05) 442-445
    CrossrefPubMedGoogle Scholar
  • 4 Fakih RR, Fraser AM, Pimpalnerkar AL. Hamate fracture with dislocation of the ring and little finger metacarpals. J Hand Surg [Br] 1998; 23 (01) 96-97
    CrossrefPubMedGoogle Scholar
  • 5 Wharton DM, Casaletto JA, Choa R, Brown DJ. Outcome following coronal fractures of the hamate. J Hand Surg Eur Vol 2010; 35 (02) 146-149
    CrossrefPubMedGoogle Scholar
  • 6 Athanasiou V, Iliopoulos ID, Pantazis K, Panagopoulos A. Fracture of the body of the hamate with dorsal dislocation of the 4th and 5th metacarpals: a case report. Open Orthop J 2017; 11 (01) 447-451
    CrossrefPubMedGoogle Scholar
  • 7 Cecava ND, Finn MF, Mansfield LT. Subtle radiographic signs of hamate body fracture: a diagnosis not to miss in the emergency department. Emerg Radiol 2017; 24 (06) 689-695
    CrossrefPubMedGoogle Scholar
  • 8 Uhl RL, Campbell M. Hamate fracture-dislocation: a case report. J Hand Surg Am 1995; 20 (04) 578-580
    CrossrefPubMedGoogle Scholar
  • 9 Cain Jr JE, Shepler TR, Wilson MR. Hamatometacarpal fracture-dislocation: classification and treatment. J Hand Surg Am 1987; 12 5 Pt 1 762-767
    CrossrefPubMedGoogle Scholar
  • 10 Kim JK, Shin SJ. A novel hamatometacarpal fracture-dislocation classification system based on CT scan. Injury 2012; 43 (07) 1112-1117
    CrossrefPubMedGoogle Scholar
  • 11 Bao B, Zhu H, Zheng X. Plate versus Kirschner wire fixation in treatment of fourth and fifth carpometacarpal fracture-dislocations: a retrospective cohort study. Int J Surg 2018; 52: 293-296
    CrossrefPubMedGoogle Scholar
  • 12 Büren C, Gehrmann S, Kaufmann R, Windolf J, Lögters T. Management algorithm for index through small finger carpometacarpal fracture dislocations. Eur J Trauma Emerg Surg 2016; 42 (01) 37-42
    CrossrefPubMedGoogle Scholar
  • 13 Brinkman JN, Hartholt KA, de Vries MR. Multiple carpometacarpal dislocations and an associated fracture of the hamate: an uncommon injury. BMJ Case Rep 2016; 2016: 15
    PubMedGoogle Scholar
  • 14 Gil JA, Goodman AD, Starr A. Coronal hamate fracture associated with carpometacarpal dislocations of all of the fingers: review of the literature and case report. Hand (N Y) 2017; 12 (05) NP51-NP54
    CrossrefPubMedGoogle Scholar
  • 15 Cobb WA, Dingle L, Zarb Adami R, Rodrigues J. Management of fracture-dislocations of the little finger carpometacarpal joint: a systematic review. J Hand Surg Eur Vol 2018; 43 (05) 530-538
    CrossrefPubMedGoogle Scholar
  • 16 Terrono A, Ferenz CC, Nalebuff EA. Delayed diagnosis in non-union of the body of the hamate: a case report. J Hand Surg [Br] 1989; 14 (03) 329-331
    CrossrefPubMedGoogle Scholar
  • 17 Thomas AP, Birch R. An unusual hamate fracture. Hand 1983; 15 (03) 281-286
    PubMedGoogle Scholar
  • 18 Hirano K, Inoue G. Classification and treatment of hamate fractures. Hand Surg 2005; 10 (2-3) 151-157
    CrossrefPubMedGoogle Scholar
  • 19 Kimura H, Kamura S, Akai M, Ohno T. An unusual coronal fracture of the body of the hamate bone. J Hand Surg Am 1988; 13 (05) 743-745
    CrossrefPubMedGoogle Scholar
  • 20 Loth TS, McMillan MD. Coronal dorsal hamate fractures. J Hand Surg Am 1988; 13 (04) 616-618
    CrossrefPubMedGoogle Scholar
  • 21 Andresen R, Radmer S, Sparmann M, Bogusch G, Banzer D. Imaging of hamate bone fractures in conventional X-rays and high-resolution computed tomography. An in vitro study. Invest Radiol 1999; 34 (01) 46-50
    CrossrefPubMedGoogle Scholar
  • 22 McDonald LS, Shupe PG, Hammel N, Kroonen LT. The intermetacarpal angle screening test for ulnar-sided carpometacarpal fracture-dislocations. J Hand Surg Am 2012; 37 (09) 1839-1844
    CrossrefPubMedGoogle Scholar
  • 23 Gillespy III T, Stork JJ, Dell PC. Dorsal fracture of the hamate: distinctive radiographic appearance. Am J Roentgenol 1988; 151 (02) 351-353
    CrossrefPubMedGoogle Scholar
  • 24 Moriya K, Saito H, Takahashi Y, Ohi H. Divergent fracture-dislocation of the hamatometacarpal joint: case report. J Hand Surg Am 2011; 36 (01) 47-51
    CrossrefPubMedGoogle Scholar
  • 25 Van Schil P, De Smet C, Schoofs E. Fracture of the body of the hamate bone. Case report. Arch Orthop Trauma Surg 1988; 107 (03) 191-192
    CrossrefPubMedGoogle Scholar
  • 26 Milch H. Fracture of the hamate bone. J Bone Jt Surg Am 1934; 16: 459-462
    PubMedGoogle Scholar
  • 27 Ebraheim NA, Skie MC, Savolaine ER, Jackson WT. Coronal fracture of the body of the hamate. J Trauma 1995; 38 (02) 169-174
    CrossrefPubMedGoogle Scholar
  • 28 Takami H, Takahashi S, Hiraki S. Coronal fracture of the body of the hamate: case reports. J Trauma 1992; 32 (01) 110-112
    CrossrefPubMedGoogle Scholar
  • 29 Ogunro O. Fracture of the body of the hamate bone. J Hand Surg Am 1983; 8 (03) 353-355
    CrossrefPubMedGoogle Scholar
  • 30 Borse VH, Hahnel J, Faraj A. Lessons to be learned from a missed case of hamate fracture: a case report. J Orthop Surg Res 2010; 5: 64
    CrossrefPubMedGoogle Scholar
  • 31 Snoap T, Habeck J, Ruiter T. Hamate fracture. Eplasty 2015; 15 (15) ic28
    PubMedGoogle Scholar
  • 32 Gella S, Borse V, Rutten E. Coronal fractures of the hamate: are they rare or rarely spotted?. J Hand Surg Eur Vol 2007; 32 (06) 721-722
    CrossrefPubMedGoogle Scholar
  • 33 Chalmers RL, Kong KC. An unusual fracture of the hamate. J Hand Surg [Br] 2006; 31 (05) 577-578
    CrossrefPubMedGoogle Scholar