Abstract
Objective
To determine interobserver agreement and reliability of different radiological parameters in the assessment of fracture-dislocation of the 4th and 5th carpometacarpal joints (FD CMC 4–5) and associated hamate fracture on radiographs.
Materials and methods
A retrospective, consecutive case series of 53 patients diagnosed with FD CMC 4–5. Emergency room diagnostic radiology images were reviewed by four independent observers. The reviews included assessment of radiological patterns and parameters in relation to CMC fracture-dislocations and associated injuries previously described in the literature, to analyze their diagnostic power (specificity and sensitivity) and reproducibility (interobserver reliability).
Results
Among 53 patients, mean age 35.3 years, dislocation of the 5th CMC joint was present in 32/53 (60%) of patients, mostly (11/32 [34%]) associated with 4th CMC dislocation and base of 4th and 5th metacarpal fracture. The most common presentation of hamate fracture, in 4/18 (22%), was associated with combined 4th and 5th CMC dislocation and base of metacarpal fracture. Computed tomography (CT) was performed in 23 patients. Performing CT scan was significantly associated with hamate fracture diagnosis (p < 0.001). Interobserver agreement was slight (0–0.641) for most of the parameters and diagnoses. Sensitivity ranged from 0 to 0.61. Overall, the described parameters had low sensitivity.
Conclusion
Radiological parameters described for assessment of fracture-dislocation of the 4th and 5th CMC joints and associated hamate fracture have a slight interobserver agreement index in plain X-ray and low sensitivity for diagnostic assessment. These results suggest the need for emergency medicine diagnostic protocols that include CT scan for such injuries.
ClinicalTrials.gov identifier
NCT04668794
Similar content being viewed by others
References
Cano Gala C, Pescador Hernández D, RendónDíaz DA, LópezOlmedo J, Blanco BJ. 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 Elsevier. 2013;4:442–5.
SarabiaCondés JM, IbañezMartínez L, Sánchez Carrasco MA, Carrillo Julia FJ, SalmerónMartínez EL. Fracturas del ganchoso. Rev Esp Cir Ortop Traumatol Ediciones Doyma, SL. 2015;59:299–306.
Milch H. Fracture of the hamate bone [Internet]. Jbjs. 1934 [cited 2021 Dec 24]. p. 459–62.
Cain JE, Shepler TR, Wilson MR. Hamatometacarpal fracture-dislocation: Classification and treatment. J Hand Surg Am J Hand Surg Am. 1987;12:762–7.
Ebraheim NA, Skie MC, Savolaine ER, Jackson WT. Coronal fracture of the body of the hamate. J Trauma - Inj Infect Crit Care Lippincott Williams and Wilkins. 1995;38:169–74.
Garcia-Elias M, Rossignani P, Cots M. Combined fracture of the hook of the hamate and palmar dislocation of the fifth carpometacarpal joint. J Hand Surg Eur Vol SAGE Publications Ltd. 1996;21:446–50.
Henderson JJ, Arafa MAM. Carpometacarpal dislocation An easily missed diagnosis. J Bone Jt Surg - Ser B. 1987;69:212–4.
Eder C, Scheller A, Schwab N, Krapohl BD. Hamate’s coronal fracture diagnostic and therapeutic approaches based on a long-term follow-up. GMS Interdiscip Plast Reconstr Surg DGPW German Medical Science. 2019;8:Doc05.
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 [Internet]. SAGE Publications Ltd; 2018 [cited 2020 May 5];43:530–8
Spencer J, Hunt SL, Zhang C, Walter C, Everist B. Radiographic signs of hook of hamate fracture: evaluation of diagnostic utility. Skeletal Radiol Springer Verlag. 2019;48:1891–8.
Davis DL. Hook of the hamate: The spectrum of often missed pathologic findings. Am J Roentgenol Am Roentgen Ray Soc. 2017;209:1110–8.
Roche S, Lenehan B, Street J, O’Sullivan M. Fourth metacarpal base fracture in association with coronal hamate fracture. Inj Extra. 2005;36:316–8.
Welling RD, Jacobson JA, Jamadar DA, Chong S, Caoili EM, Jebson PJL. MDCT and radiography of wrist fractures: Radiographic sensitivity and fracture patterns. Am J Roentgenol AJR Am J Roentgenol. 2008;190:10–6.
Fisher MR, Rogers LF, Hendrix RW. Systematic approach to identifying fourth and fifth carpometacarpal joint dislocations. Am J Roentgenol American Roentgen Ray Society. 1983;140:319–24.
Hirano K, Inoue G. Classification and treatment of hamate fractures. Hand Surg Hand Surg. 2005;10:151–7.
Landis JR, Koch GG. The Measurement of Observer Agreement for Categorical Data Biometrics. JSTOR. 1977;33:159.
Parikh R, Mathai A, Parikh S, Sekhar GC, Thomas R. Understanding and using sensitivity, specificity and predictive values. Indian J Ophthalmol Medknow Publ Media Pvt Ltd. 2008;56:45–50.
Münn F, Laun RA, Asmus A, Bülow R, Bakir S, Haralambiev L, et al. Detection of fractures of hand and forearm in whole-body CT for suspected polytrauma in intubated patients. BMC Musculoskelet Disord. BioMed Central Ltd.; 2020;21
Kramer SB, Selles CA, Bakker D, Schep NWL. Comparison of extra-articular radiographic parameters of distal radius fractures on plain radiographs and CT scans. J Hand Surg Eur Vol SAGE Publications Ltd. 2022;47:142–9.
Jakubietz MG, Mages L, Zahn RK, Kenn W, Jakubietz RG, Meffert RH. The role of CT scan in postoperative evaluation of distal radius fractures: Retrospective analysis in regard to complications and revision rates. J Orthop Sci Elsevier. 2017;22:434–7.
Etli I, Kozaci N, Avci M, Karakoyun OF. Comparison of the diagnostic accuracy of X-ray and computed tomography in patients with wrist injury. Injury Elsevier Ltd. 2020;51:651–5.
Kim JK, Shin SJ. A novel hamatometacarpal fracture-dislocation classification system based on CT scan. Injury Injury. 2012;43:1112–7.
Eder C, Scheller A, Schwab N, Krapohl BD. Hamate’s coronal fracture: diagnostic and therapeutic approaches based on a long-term follow-up. GMS Interdiscip Plast Reconstr Surg DGPW [Internet]. GMS Interdiscip Plast Reconstr Surg DGPW; 2019 [cited 2023 May 5];8:Doc05. Available from: http://www.ncbi.nlm.nih.gov/pubmed/30984513
Addala TE, Greffier J, Hamard A, Snene F, Bobbia X, Bastide S, et al. Early results of ultra-low-dose CT-scan for extremity traumas in emergency room. Quant Imaging Med Surg AME Publishing Company. 2022;12:4248–58.
Falkowski AL, Kovacs BK, Schwartz FR, Benz RM, Stieltjes B, Hirschmann A. Comparison of 3D X-ray tomography with computed tomography in patients with distal extremity fractures Skeletal Radiol. Springer Sci Business Media Deutschland GmbH. 2020;49:1965–75.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Ethical approval
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Ethical institutional board committee approved this study: IIBSP-FLC-2020–29. Approval was obtained and in keeping with the policies for a retrospective review, informed consent was not required.
Conflict of Interest
The authors declare that they have no conflict of interest.
Additional information
Publisher's note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.
About this article
Cite this article
Fa-Binefa, M., Almenara, M., Mata-Muñoz, J.M. et al. Retrospective interobserver agreement on diagnoses of 4th and 5th carpometacarpal fracture-dislocation and hamate fracture in plain X-ray – Is CT essential after ulnar carpometacarpal pain?. Skeletal Radiol 52, 2427–2433 (2023). https://doi.org/10.1007/s00256-023-04366-9
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00256-023-04366-9