Abstract
Aim
This study reviews the surgical outcomes of using dorsal buttress plate for open reduction and internal fixation of ulnar (5th, or 4th and 5th) CMCJ fracture subluxation or dislocations.
Methods
A retrospective review of 11 patients at our center who underwent operative fixation with dorsal buttress plating technique was performed. The surgery was performed between February 2012 and March 2017. Outcome measurements include radiographic evaluation of time to union, grip strength, and range of motion of the wrist.
Results
Of 11 patients in our case series, eight had injuries involving both 4th and 5th CMCJs, while three had isolated involvement of 5th CMCJ. Mean time to union on radiographs was 48 days (IQR 17.0; range 30–88). The median palmar flexion and dorsiflexion of the wrist were 56° (IQR 11.3; range 50°–80°) and 65° (IQR 10.0; range 60°–80°) respectively. Patients regained a median of 79% of grip strength (IQR: 36.0, range 43–100). All fingers achieved full range of motion, and no patient had scissoring of the fingers. Two patients had temporary mild numbness over the dorsoulnar aspect of the hand in the region of the 4th webspace. Five patients underwent removal of implants due to plate breakage (n = 2), or mild pain or pain with cold (n = 3). All patients were well after plate removal, and all the patients with pain had resolution of pain after implant removal.
Conclusion
The dorsal buttress plate is a viable option for fixation of ulnar CMCJ fracture dislocations to allow early mobilization.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Dubert TP, Khalifa H (2009) “Stabilized arthroplasty” for old fracture dislocations of the fifth carpometacarpal joint. Tech Hand Up Extrem Surg. 13(3):134–136
Goedkoop AY, Van Onselen EB, Karim RB, Hage JJ (2000) The ‘mirrored’ Bennett fracture of the base of the fifth metacarpal. Arch Orthop Trauma Surg 120(10):592–593
Mueller JJ (1986) Carpometacarpal dislocations: report of five cases and review of the literature. J Hand Surg Am 11(2):184–188
Valente M, Saggin G, Alecci V (2009) Pure isolated dorsal dislocation of the fifth carpometacarpal joint. Chir Organi Mov 93(2):97–100
Foster RJ (1996) Stabilization of ulnar carpometacarpal dislocations or fracture dislocations. Clin Orthop Relat Res 327:94–97
Garcia-Elias M, Rossignani P, Cots M (1996) Combined fracture of the hook of the hamate and palmar dislocation of the fifth carpometacarpal joint. J Hand Surg Br 21(4):446–450
Hsu JD, Curtis RM (1970) Carpometacarpal dislocations on the ulnar side of the hand. J Bone Joint Surg Am 52(5):927–930
Slutsky DJ (2011) Arthroscopic reduction and percutaneous fixation of fifth carpometacarpal fracture dislocations. Hand Clin 27(3):361–367
Smith GR, Yang SS, Weiland AJ (1996) Multiple carpometacarpal dislocations. A case report and review of treatment. Am J Orthop (Belle Mead NJ) 25(7):502–506
Wharton DM, Casaletto JA, Choa R, Brown DJ (2010) Outcome following coronal fractures of the hamate. J Hand Surg Eur 35(2):146–149
Cain JE, Shepler TR, Wilson MR (1987) Hamatometacarpal fracture-dislocation: classification and treatment. J Hand Surg Am 12(5):762–767
Yoshida R, Shah MA, Patterson RM, Buford WL Jr, Knighten J, Viegas SF (2003) Anatomy and pathomechanics of ring and small finger carpometacarpal joint injuries. J Hand Surg Am 28(6):1035–1043
Schortinghuis J, Klasen HJ (1997) Open reduction and internal fixation of combined fourth and fifth carpometacarpal (fracture) dislocations. J Trauma 42(6):1052–1055
Tan ES, Tay SC (2016) Dorsal buttress plate fixation of ulnar carpometacarpal joint fracture dislocations. Tech Hand Up Extrem Surg 20(2):77–82
Mozaffarian K, Vosoughi AR, Hedjazi A, Zarenezhad M, Nazmi MK (2012) The safest direction of percutaneous pinning for achieving firm fixing of the fifth carpometacarpal joint. J Orthop Sci 17(6):757–762
Bushnell BD, Draeger RW, Crosby CG, Bynum DK (2008) Management of intra-articular metacarpal base fractures of the second through fifth metacarpals. J Hand Surg Am 33(4):573–583
Kural C, Başaran SH, Ercin E, Bayrak A, Bilgili MG, Baca E (2013) Fourth and fifth carpometacarpal fracture dislocations. Acta Orthop Traumatol Turc 48(6):655–660
Fisher MR, Rogers LF, Hendrix RW (1983) Systematic approach to identifying fourth and fifth carpometacarpal joint dislocations. AJR Am J Roentgenol 140(2):319–324
Kim JK, Shin SJ (2012) A novel hamatometacarpal fracture-dislocation classification based on CT scan. Injury 43(7):1112–1117
Norkin CC, White DJ (2009) Basic concepts. In measurement of joint motion: a guide to goniometry. FA Davis, Philadelphia, pp 3–18
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
There is no conflicting interest.
Ethical approval
Ethics approval was obtained from the Institutional Ethical Review Board (CIRB Reference Number: 2014/887/D).
Rights and permissions
About this article
Cite this article
Tay, S.C., Leow, M.Q.H. & Tan, E.S. Use of dorsal buttress plate fixation for ulnar carpometacarpal joint fracture dislocations for early mobilization: outcomes of 11 cases. Musculoskelet Surg 103, 77–82 (2019). https://doi.org/10.1007/s12306-018-0571-7
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s12306-018-0571-7