Early Recognition and Treatment of Carpometacarpal Fractures and Dislocations

Abstract

Carpometacarpal (CMC) injuries can easily be missed in more than half of the cases. Early diagnosis is crucial for treatment. Although the clinical aspect can lead the treating physician to suspect that anything is going wrong, appropriate radiographs, especially in the lateral view, are crucial for the diagnosis. The most common CMC fracture dislocations affects the 4^th and 5^th joints. Treatment will depend on the type of injury and on the degree of joint involvement. Reduction and fixation are usually required. When only one ray is affected, usually the 5^th, closed reduction and fixation with Kirschner wires can be performed. In complex cases, open reduction and fixation are required, with Kirschner wires being the most commonly used materials. After the hardware removal, rehabilitation can be intensified. If an appropriate reduction has been achieved, satisfactory functional and radiological outcomes are expected.

Keywords

carpometacarpal joints/injuries - carpometacarpal joints/pathology - carpometacarpal joints/surgery - joint dislocations - hand bones

Note

The present review article does not require submission to the Research Ethics Committee, to the best of my knowledge.

Publication History

Received: 12 August 2019

Accepted: 20 February 2020

Article published online:
31 March 2021

• Referências

• 1 Steinmetz G, Corning E, Hulse T. et al. Carpometacarpal Fracture-Dislocations: A Retrospective Review of Injury Characteristics and Radiographic Outcomes. Hand (N Y) 2019; 1558944719852743
• 2 Henderson JJ, Arafa MA. Carpometacarpal dislocation. An easily missed diagnosis. J Bone Joint Surg Br 1987; 69 (02) 212-214
• 3 Büren C, Gehrmann S, Kaufmann R, Windolf J, Lögters T. Management algorithm for index through small finger carpometacarpal fracture dislocations. Eur J Trauma Emerg Surg 2016; 42 (01) 37-42
• 4 Talmaç MA, Görgel MA, Dırvar F, Tok O, Özdemir HM. Functional and radiological outcomes of multiple dorsal carpometacarpal fracture dislocations treated with open reduction and internal fixation. Eklem Hastalik Cerrahisi 2019; 30 (02) 130-136
• 5 Gunther SF. The carpometacarpal joints. Orthop Clin North Am 1984; 15 (02) 259-277
• 6 Harwin SF, Fox JM, Sedlin ED. Volar dislocation of the bases of the second and third metacarpals. A case report. J Bone Joint Surg Am 1975; 57 (06) 849-851
• 7 Nakamura K, Patterson RM, Viegas SF. The ligament and skeletal anatomy of the second through fifth carpometacarpal joints and adjacent structures. J Hand Surg Am 2001; 26 (06) 1016-1029
• 8 Dobyns JH, Linscheid RL, Cooney 3rd. WP. Fractures and dislocations of the wrist and hand, then and now. J Hand Surg Am 1983; 8 (5 Pt 2): 687-690
• 9 Fisher MR, Rogers LF, Hendrix RW. Systematic approach to identifying fourth and fifth carpometacarpal joint dislocations. AJR Am J Roentgenol 1983; 140 (02) 319-324
• 10 Cain Jr JE, Shepler TR, Wilson MR. Hamatometacarpal fracture-dislocation: classification and treatment. J Hand Surg Am 1987; 12 (5 Pt 1): 762-767
• 11 Kim JK, Shin SJ. A novel hamatometacarpal fracture-dislocation classification system based on CT scan. Injury 2012; 43 (07) 1112-1117
• 12 Tay SC, Leow MQH, Tan ES. Use of dorsal buttress plate fixation for ulnar carpometacarpal joint fracture dislocations for early mobilization: outcomes of 11 cases. Musculoskelet Surg 2019; 103 (01) 77-82
• 13 Pundkare GT, Deshpande SS. Proposal for a Radiological Classification System for Carpo-Metacarpal Joint Dislocations with or without Fractures. Malays Orthop J 2018; 12 (02) 42-46
• 14 Silk G, Vetharajan N, Nagata H. Volar dislocation of the second and third carpometacarpal joints - the Lisfranc injury of the hand?. Hand Surg Rehabil 2018; 37 (05) 320-323
• 15 Zaizi A, El Yaacoubi T, El Bahraouy A. et al. Pure divergent dislocation of the index and middle finger carpometacarpal joints: A rare case. Trauma Case Rep 2019; 23: 100222
• 16 Mane PP, Bhat AK, Acharya A. Post-traumatic wind swept deformity: five volar carpometacarpal dislocations. BMJ Case Rep 2019; 12 (05) e229561
• 17 Potini VC, Gibson PD, Wu K, Li K, Tan V. A Novel Screening Technique for Ulnar-Sided Carpometacarpal Dislocations. Orthopedics 2017; 40 (02) e352-e356
• 18 Hodgson PD, Shewring DJ. The ‘metacarpal cascade lines’; use in the diagnosis of dislocations of the carpometacarpal joints. J Hand Surg Eur Vol 2007; 32 (03) 277-281
• 19 Gaheer RS, Ferdinand RD. Fracture dislocation of carpometacarpal joints: a missed injury. Orthopedics 2011; 34 (05) 399
• 20 McDonald LS, Shupe PG, Hammel N, Kroonen LT. The intermetacarpal angle screening test for ulnar-sided carpometacarpal fracture-dislocations. J Hand Surg Am 2012; 37 (09) 1839-1844
• 21 Lefere M, Dallaudière B, Omoumi P, Cyteval C, Larbi A. Rare carpometacarpal dislocations. Orthop Traumatol Surg Res 2016; 102 (06) 813-816
• 22 Iwata N, Komura S, Hirakawa A. et al. Dorsal buttress plate fixation for the treatment of fracture-dislocation of the fifth carpometacarpal joint with avulsion fracture of the hamate: a case report. Arch Orthop Trauma Surg 2019; 139 (01) 135-139
• 23 Bao B, Zhu H, Zheng X. Plate versus Kirschner wire fixation in treatment of fourth and fifth carpometacarpal fracture-dislocations: A retrospective cohort study. Int J Surg 2018; 52: 293-296
• 24 Slutsky DJ. Arthroscopic reduction and percutaneous fixation of fifth carpometacarpal fracture dislocations. Hand Clin 2011; 27 (03) 361-367
• 25 Slocum AMY, Lui TH. Isolated first carpometacarpal joint dislocation managed with closed reduction and splinting. BMJ Case Rep 2019; 12 (03) e228715
• 26 Cobb WA, Dingle L, Zarb Adami R, Rodrigues J. Management of fracture-dislocations of the little finger carpometacarpal joint: a systematic review. J Hand Surg Eur Vol 2018; 43 (05) 530-538
• 27 Nishimura R, Wright L, Seitz Jr WH. Augmented External Fixation of Ulnar Carpometacarpal Joint Fracture Dislocations. Tech Hand Up Extrem Surg 2019; 23 (02) 84-87
• 28 Hanel DP. Primary fusion of fracture dislocations of central carpometacarpal joints. Clin Orthop Relat Res 1996; (327) 85-93
• 29 Hartwig RH, Louis DS. Multiple carpometacarpal dislocations.A review of four cases. J Bone Joint Surg Am 1979; 61 (6A): 906-908
• 30 Na KT, Lee SU, Joo SY, Nho JY. Concurrent Index-to-Little Finger Dorsal Dislocations of the Carpometacarpal Joints with Carpal Bone Fractures. Indian J Orthop 2019; 53 (02) 374-376
• 31 Meraghni N, Bacle G, Marteau E, Bouju Y, Laulan J. Results of the Dubert procedure for chronic painful fracture-dislocations of the fifth carpometacarpal joint. A report of 6 cases. Hand Surg Rehabil 2017; 36 (05) 373-377