[Acute carpometacarpal joint dislocation of the long fingers: study of 100 cases]

The authors report clinical and radiological results of carpometacarpal dislocations treated in emergency over a period of 7 years (2002-2009). Mechanisms of injury and diagnosis pitfalls are specified, and treatment options are discussed.

A retrospective study of 100 carpometacarpal dislocations was performed. Most commonly trauma was a punch (56%). In half the cases, lesions were located only within the fifth ray. Carpal or metacarpal fractures were associated in a majority of cases (88%). Surgical treatment was carried out in all cases either by closed reduction and percutaneous pinning (60%), or by open reduction and internal fixation (40%). The mean follow-up was 5 months. Anatomic reduction of dislocation, consolidation and reduction of associated fractures were analysed on the last follow-up x-rays. Evaluation tools were pain score, range of motion and grip strength.

Radiological criteria were satisfactory in 68% of cases. Non-satisfactory X ray criteria were mainly associated with closed reduction and percutaneous pinning. At final follow up, 81% of the patients were pain-free and had recovered complete range of motion. In 16% of patients pain was only found during grip strength test.

Carpometacarpal luxations are not as rare as suggested by literature. Early diagnosis and treatment are essential for the prognosis. Increasing indications of a scan enable better analysis by identifying all injuries. Open reduction by which allows the treatment of all associated injuries must be promoted.