Abstract
Purpose
Injuries to the carpometacarpal (CMC) joints are rare. The most common CMC fracture dislocations occur in the ring and small finger CMC joints. The aim of this study was to review the structured diagnostic procedure and different treatment options.
Methods
We review the importance of early and correct diagnosis in CMC fracture dislocation, because it is needed to ensure pain-free hand function. Moreover, we contrast different therapeutic options, including non-operative and surgical therapy for CMC fracture dislocation.
Results
If a clinical suspicion for a CMC dislocation based on patient examination or radiographic findings exists, then a thin slice CT should be considered. Non-operative treatment is rarely indicated. Surgical treatment may include closed or open reduction efforts. In the case of most fracture dislocations, open reduction is recommended. Fracture fixation may be accomplished with K-wires, mini plates or screws.
Conclusion
CMC fracture dislocations of the fourth and fifth CMC joints are uncommon and often overlooked. Primary goal of treatment is to restore normal function to the hand. Therefore, operative therapy might be the method of choice.
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References
Hsu JD, Curtis RM. Carpometacarpal dislocations on the ulnar side of the hand. J Bone Joint Surg. 1970;52:927–30.
Crichlow TP, Hoskinson J. Avulsion fracture of the index metacarpal base: three case reports. J Hand Surg. 1988;13:212–4.
Gaheer RS, Ferdinand RD. Fracture dislocation of carpometacarpal joints: a missed injury. Orthopedics. 2011; doi:10.3928/01477447-20110317-29.
Jena D, Giannikas KA, Din R. Avulsion fracture of the extensor carpi radialis longus in a rugby player: a case report. Br J Sports Med. 2001;35:133–5.
Windolf J, Rueger JM, Werber KD, Eisenschenk A, Siebert H, Schädel-Höpfner M. Treatment of metacarpal fractures. Recommendations of the Hand Surgery Group of the German Trauma Society. Der Unfallchirurg. 2009; doi:10.1007/s00113-009-1630-1.
Lawlis JF, Gunther SF. Carpometacarpal dislocations. Long-term follow-up. J Bone Joint Surg. 1991;73:52–9.
Yoshida R, Shah MA, Patterson RM, Buford WL, Knighten J, Viegas SF. Anatomy and pathomechanics of ring and small finger carpometacarpal joint injuries. J Hand Surg. 2003;28:1035–43.
Nakamura K, Patterson RM, Viegas SF. The ligament and skeletal anatomy of the second through fifth carpometacarpal joints and adjacent structures. J Hand Surg. 2001; doi:10.1053/jhsu.2001.26329.
Takami H, Takahashi S, Ando M. Isolated volar displaced fracture of the ulnar condyle at the base of the index metacarpal: a case report. J Hand Surg. 1997. doi:10.1016/S0363-5023(97)80050-0.
Dobyns JH, Linscheid RL, Cooney WP. Fractures and dislocations of the wrist and hand, then and now. J Hand Surg. 1983;8:687–90.
Kadi KI, Sbiyaa M, Alami B, Rabhi I, Marzouki A, Lahrach K, Boutayeb F. Isolated radial volar dislocation of the fifth carpometacarpal joint: a rare injury. Pan Afr Med J. 2013. doi:10.11604/pamj.2013.16.90.3218.
Gehrmann SV, Kaufmann RA, Grassmann JP, Lögters T, Schädel-Höpfner M, Hakimi M, Windolf J. Fracture-dislocations of the carpometacarpal joints of the ring and little finger. J Hand Surg. 2015. doi:10.1177/1753193414562706.
Kural C, Başaran SH, Ercin E, Bayrak A, Bilgili MG, Baca E. Fourth and fifth carpometacarpal fracture dislocations. Acta Orthop Traumatol Turc. 2014;48:655–60.
de Beer JD, Maloon S, Anderson P, Jones G, Singer M. Multiple carpo-metacarpal dislocations. J Hand Surg. 1989;14:105–8.
Waugh RL, Yancey AG. Carpometacarpal dislocations with particular reference to simultaneous dislocation of the bases of the fourth and fifth metacarpals. J Bone Joint Surg. 1948;30:397–404.
Fisher MR, Rogers LF, Hendrix RW. Systematic approach to identifying fourth and fifth carpometacarpal joint dislocations. AJR Am J Roentgenol. 1983. doi:10.2214/ajr.140.2.319.
Fisher MR, Rogers LF, Hendrix RW, Gilula LA. Carpometacarpal dislocations. Crit Rev Diagn Imaging. 1984;22:95–126.
Cain JE, Shepler TR, Wilson MR. Hamatometacarpal fracture-dislocation: classification and treatment. J Hand Surg. 1987;12:762–7.
Gehrmann SV, Grassmann JP, Schneppendahl J, Kaufmann RA, Windolf J, Hakimi M, Schädel-Höpfner M. Treatment strategy for carpometacarpal fracture dislocation. Der Unfallchirurg. 2011. doi:10.1007/s00113-011-2006-x.
Niechajev I. Dislocated intra-articular fracture of the base of the fifth metacarpal: a clinical study of 23 patients. Plast Reconstr Surg. 1985;75:406–10.
Frick L, Mezzadri G, Yzem I, Plotard F, Herzberg G. Acute carpometacarpal joint dislocation of the long fingers: study of 100 cases. Chir Main. 2011. doi:10.1016/j.main.2011.06.010.
Acknowledgments
Radiographic pictures are kindly provided from and printed by courtesy of the Institute of Diagnostic and Interventional Radiology, University Hospital Düsseldorf, Germany (Director: Univ.-Prof. Dr. G. Antoch).
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Carina Büren, Sebastian Gehrmann, Robert Kaufmann, Joachim Windolf und Tim Lögters declare that they have no conflict of interest.
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Büren, C., Gehrmann, S., Kaufmann, R. et al. Management algorithm for index through small finger carpometacarpal fracture dislocations. Eur J Trauma Emerg Surg 42, 37–42 (2016). https://doi.org/10.1007/s00068-015-0611-z
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DOI: https://doi.org/10.1007/s00068-015-0611-z