Treatment of Fourth and Fifth Carpometacarpal Fracture-Dislocations in Punching Injuries With Motion-Sparing Hamate...

Area of Science:

• Orthopedic Surgery
• Hand Surgery
• Traumatology

Background:

• Fourth and fifth carpometacarpal (CMC) fracture-dislocations are common, often resulting from punching injuries.
• These injuries are typically unstable, with dorsal metacarpal dislocations being the most frequent presentation.
• Current management for unstable fracture-dislocations involves closed reduction and percutaneous pinning, with open reduction needed for delayed cases.

Purpose of the Study:

• To present a novel plating technique for managing acute and delayed, unstable fourth and/or fifth CMC fracture-dislocations.
• To evaluate the efficacy of this plating method in maintaining reduction and allowing physiological joint motion.
• To establish this technique as an effective surgical alternative for CMC joint injuries.

Main Methods:

• A plating technique was utilized for both acute and delayed, unstable fourth and/or fifth CMC fracture-dislocations.
• The technique employs a dorsal buttressing mechanism to maintain joint reduction.
• This method facilitates physiological motion at the carpometacarpal joint.

Main Results:

• The novel plating technique successfully maintained reduction of unstable fourth and fifth CMC fracture-dislocations.
• Patients experienced the initiation of range of motion within the first week postoperatively.
• Full fist formation and digital extension were achieved 4 to 6 weeks postoperatively.

Conclusions:

• This plating technique provides an effective surgical treatment for acute and delayed fourth and fifth CMC fracture-dislocations.
• The method allows for early rehabilitation and restoration of hand function.
• Excellent outcomes were observed in patients treated with this novel approach up to 12 weeks post-injury.