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

Svenna H. W. L. Verhiel; William J. Knaus; Frank J. Simeone; Chaitanya S. Mudgal

doi:10.1055/s-0039-1692326

Journal of Hand and Microsurgery, Table of Contents

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

¹Department of Orthopaedic Surgery, Hand and Upper Extremity Service, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States

,

William J. Knaus

¹Department of Orthopaedic Surgery, Hand and Upper Extremity Service, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States

,

Frank J. Simeone

²Department of Radiology, Musculoskeletal Imaging and Intervention, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States

,

Chaitanya S. Mudgal

¹Department of Orthopaedic Surgery, Hand and Upper Extremity Service, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States

› Author Affiliations

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

Full Text

References

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