Fourth and fifth carpometacarpal fracture dislocations

Area of Science:

• Orthopedic Surgery
• Hand Surgery
• Traumatology

Background:

• Carpometacarpal (CMC) fracture dislocations, particularly of the 4th and 5th rays, can present diagnostic challenges.
• Prompt management is essential for restoring hand function and preventing adverse outcomes.

Purpose of the Study:

• To evaluate the mid-term results of surgical treatment for 4th and 5th CMC fracture dislocations.
• To assess the impact of diagnosis and treatment timing on functional and radiological outcomes.

Main Methods:

• A cohort of 9 patients with 4th and 5th CMC dislocations treated surgically between 2008 and 2012 was retrospectively reviewed.
• Patients underwent open reduction and internal fixation, with a mean follow-up of 19.4 months.
• Radiological assessment and hand grip strength measurements (comparing injured to uninjured sides) were performed.

Main Results:

• A statistically significant difference in hand grip strength was observed between the injured and uninjured sides (p<0.05).
• Three patients reported pain during heavy labor, with two experiencing delayed diagnosis and one with a comminuted fracture unable to return to previous work.
• No recurrent dislocations or complications requiring revision surgery were reported.

Conclusions:

• Early diagnosis and surgical intervention for 4th and 5th CMC dislocations yield favorable anatomical and functional results.
• Delayed or missed diagnoses can lead to significant radiological and functional impairments.
• Thorough physical and radiological examinations are vital to avoid overlooking CMC dislocations.