Rate of clinically significant posttraumatic arthritis after small finger intra-articular carpometacarpal fractures

Although small finger intra-articular carpometacarpal joint fractures are relatively common hand injuries, few studies in the orthopedic literature report their clinical outcomes. The goal of this study was to analyze the rate of symptomatic posttraumatic arthritis following small finger intra-articular carpometacarpal joint fractures. The authors performed a chart review of 82 consecutive patients with a small finger intra-articular carpometacarpal fractures treated at their institution over a 5-year period. Operative indications included irreducible small finger intra-articular carpometacarpal fractures and recurrent small finger carpometacarpal joint instability after attempted reduction. Group 1 included 66 patients with small finger intra-articular carpometacarpal fractures who were treated with cast immobilization alone for 6 weeks, whereas group 2 included 16 patients treated surgically followed by 6 weeks of cast immobilization. Clinical outcome parameters included posttreatment serial radiographs, a visual scale based on subjective pain scores (0-10) as part of a routine clinic intake form, and the need for subsequent small finger carpometacarpal arthrodesis. All patients included in the study had a minimum 12-month follow-up. In group 1, 6 (9.1%) of 66 patients developed symptomatic posttraumatic arthritis and required a subsequent small finger carpometacarpal arthrodesis. In group 2, none of the patients developed symptomatic posttraumatic arthritis or required arthrodesis. This study reports a relatively higher rate of small finger carpometacarpal arthrodesis after closed treatment alone for intra-articular small finger carpometacarpal fractures compared with open treatment, suggesting that anatomic alignment is important in this injury pattern.