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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
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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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