Subscribe to RSS
DOI: 10.1055/s-0041-1740485
Is It Possible to Perform Fifth Carpometacarpal Joint Arthroscopy? Cadaveric Study on Its Feasibility, Safety, and Potential Hazards in Portal Creation
![](https://www.thieme-connect.de/media/jws/202302/lookinside/thumbnails/10-1055-s-0041-1740485_2100073pro-1.jpg)
Abstract
Background Fifth carpometacarpal joint (CMCJ) fracture dislocation is a relatively rare injury and most will require operative treatment because of its unstable nature. Improper reduction and fixation lead to joint surface destruction, pain, and reduced grasping power. Intra-articular fragment reduction is often obscured by dorsally displaced ulnar fragment. Therefore, fifth CMCJ arthroscopy can be advantageous in assisting intra-articular fragment reduction. However, there is no detailed description of the portal landmarks or portals' relationship with adjacent important structures in the literature.
Purposes To explore the feasibility and safety of fifth CMCJ arthroscopy, locations of the portals are examined in cadaveric hand specimens. Their proximity to important anatomical structures such as dorsal cutaneous branch of ulnar nerve (DCBUN), ring finger and little finger extensor digitorum communis (EDC), and extensor digiti minimi (EDM) is measured.
Methods Fifth CMCJ arthroscopy is performed on 11 cadaveric hand specimens by specialist-level surgeon. The portals are marked and portal positions are further confirmed under the fluoroscopy. Then the cadaveric specimens were undergone anatomical dissection by specialist-level surgeon. During dissection, the spatial relationship between the portal positions and DCBUN, EDC to ring finger and little finger, and EDM is identified. The distance between the portals and the above important structures was measured in millimeters.
Results DCBUN was consistently found between fourth metacarpohamate (4-MH) and fifth metacarpohamate (5-MH) portals, with it being closer to the latter (mean distance, 2.03 mm; range, 0–4.43 mm; standard deviation [SD], 1.09 mm). The closest tendon for 4-MH portal is ring finger EDC (mean distance, 2.65 mm; range, 0–5.89 mm; SD, 1.78 mm), while 5-MH portal and accessory portal were closest to EDC (mean distance, 1.88 mm; range, 0–3.69 mm; SD, 1.25 mm) and EDM (mean distance, 7.79 mm; range, 6.63–10.72 mm; SD, 1.49 mm), respectively. During the process of specimen dissection, we found no damage to the above structures after portal introduction.
Conclusion The above findings support the use of fifth CMCJ arthroscopy, which can be used for assisted reduction in fifth metacarpal base fracture dislocation and hamate body fracture. Gentle soft tissue spreading technique during portal creation prevents injury to the important structure surrounding the portals.
Level of evidence This is a Level V study.
Keywords
fifth carpometacarpal joint arthroscopy - dorsal cutaneous branch of ulnar nerve - extensor digitorum communis - extensor digiti minimi - cadaveric studyEthical Approval
This research project is approved and registered under Joint Chinese University of Hong Kong-New Territories East Cluster Clinical Research Ethics Committee, with the reference number of CREC 2019.064.
Authors' Contributions
Cadaveric study was performed at Orthopaedic Learning Centre in Prince of Wales Hospital. K.S.C.J.J. researched the literature, conceived the study, developed the protocol, obtained ethical approval, conducted cadaveric sessions, analyzed the data, and wrote the manuscript. P.H. participated in cadaveric sessions and data analysis. All authors reviewed and edited the manuscript and approved the final version of the manuscript.
Publication History
Received: 26 May 2021
Accepted: 09 November 2021
Article published online:
06 January 2022
© 2022. Thieme. All rights reserved.
Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA
-
Reference
- 1 Lilling M, Weinberg H. The mechanism of dorsal fracture dislocation of the fifth carpometacarpal joint. J Hand Surg Am 1979; 4 (04) 340-342
- 2 Ho PC, Tse WL, Wong WYC, Hung LK. Advances in arthroscopic surgery of the wrist: from resection to reconstruction. Medicina fluminensis 2015; 51 (01) 52-59
- 3 Badia A. Small joint arthroscopy. In: Geissler WB. ed. Wrist and Elbow Arthroscopy: A Practical Surgical Guide to Techniques. New York: Springer; 2015: 321-340
- 4 Koo SCJJ, Leung KYA, Chau WW, Ho PC. Comparing outcomes between arthroscopic-assisted reduction and fluoroscopic reduction in AO type C distal radius fracture treatment. J Wrist Surg 2021; 10 (02) 102-110
- 5 Slutsky DJ. Arthroscopic reduction and percutaneous fixation of fifth carpometacarpal fracture dislocations. Hand Clin 2011; 27 (03) 361-367
- 6 Adolfsson L. Arthroscopy of the elbow joint: a cadaveric study of portal placement. J Shoulder Elbow Surg 1994; 3 (02) 53-61
- 7 Stothers K, Day B, Regan WR. Arthroscopy of the elbow: anatomy, portal sites, and a description of the proximal lateral portal. Arthroscopy 1995; 11 (04) 449-457
- 8 Vaishaly KB, Amol AS, Dinesh KP, Sumedha C. Anatomical study of the ankle joint in relation to the anterior, the posterior and the (new) medial arthroscopic portals: a cadaveric study. Int J Curr Res Rev 2017; 9 (08) 21-29
- 9 Ferkel RD, Small HN, Gittins JE. Complications in foot and ankle arthroscopy. Clin Orthop Relat Res 2001; (391) 89-104
- 10 Scheibling B, Koch G, Clavert P. Cadaver study of anatomic landmark identification for placing ankle arthroscopy portals. Orthop Traumatol Surg Res 2017; 103 (03) 387-391
- 11 Kerr HD. Hamate-metacarpal fracture dislocation. J Emerg Med 1992; 10 (05) 565-568
- 12 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: 447-451
- 13 Dubert T. “Arthroplastie stabilisée” du cinquième métacarpien. Proposition thérapeutique pour le traitement des fractures-luxations anciennes du 5e métacarpien. Ann Chir Main Memb Super 1994; 13 (05) 363-365