Stabilization of ulnar carpometacarpal dislocations or fracture dislocations

For the management of ulnar carpometacarpal dislocations or fracture dislocations, various authors have suggested closed reduction and percutaneous pin fixation, or open reduction and internal fixation with the use of transversely oriented pins. The methods can be problematic with failure of fixation or injury to tendons or nerves. A stable internal fixation alternative uses intramedullary metacarpal Steinmann pins or Kirschner wires, passed across the carpometacarpal joint into the hamate. If the fixation devices exit through the triquetrum and the lunate, then the finger metacarpal phalangeal joints may be left with full active motion. This method has provided ease of placement, stability, and no loss of fixation in 9 cases. An associated coronal fracture of the hamate may be fixed with small Kirschner wires or with a small lag screw, which can be placed through the same incision.