Traumatic dislocation of the thumb carpometacarpal joint: early ligamentous reconstruction versus closed reduction...

Early reconstruction of the thumb carpometacarpal (CMC) joint after traumatic dislocation, when instability is present, may decrease the incidence of recurrent instability and post-traumatic joint degeneration. We report two retrospective cohort groups of patients who had sustained a traumatic thumb CMC joint dislocation. The first 8 patients, group A, were treated with closed reduction and pinning. Because the results were unsatisfactory with 4 patients, requiring revision surgery for recurrent instability in 3 and degenerative arthritis in 1, the treatment plan was changed to open reduction with a flexor carpi radialis weave, group B. The 9 patients in group B underwent early (an average of 7 days after injury) ligamentous reconstruction to decrease the incidence of joint damage from recurrent instability and improve long-term functional results. For patients in group B with a minimum follow-up period of 2 years, pain was not a major problem, and range of motion and grip strength were essentially preserved. The functional variables affected most in both groups were thumb abduction, which was decreased by 10%, and pinch strength, which was decreased by 13%, in group B, as compared to 20% and 19%, respectively, for the patients in group A. Radiographically, the joint space was slightly narrowed (Eaton stage II) in 3 cases in group B; however, these were asymptomatic. In group A, 5 patients demonstrated degenerative changes of the CMC joint (3 Eaton stage II, 2 stage III), and 3 patients were symptomatic after treatment.