Fracture dislocations of the carpometacarpal joints of the fingers

Bhardwaj, Praveen; Sivakumar, Brahman; Vallurupalli, Aashish; Pai, Mithun; Sabapathy, S Raja

doi:10.1016/j.jcot.2020.05.039

Cited by 13 publications

(34 citation statements)

References 51 publications

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“…8,[13][14][15] The most common causes are a blow with clenched fist (about half of the patients in three case series in literature), a fall from height, and car and motorcycle accidents. 2,5,9,16 CMC dislocations are notoriously overlooked injuries during the initial evaluation (up to 71% according to Hen-derson and Arafa). 17 The main reasons for that is the excessive swelling and pain that makes clinical examination of the hand difficult, the serious concomitant injuries that may distract the attention of the clinician, and the overlapping of the metacarpals on the lateral X-ray, which make its interpretation challenging.…”

Section: Discussionmentioning

confidence: 99%

“…1,[21][22][23] The articular surfaces should be parallel, with a uniform joint space, and there should be no bony overlaps. 9,20,[24][25][26][27][28] In recent years, the role of a thin slice CT scan has been pointed out, as it can confirm the diagnosis in difficult cases, provide a better assessment of the joint surfaces and concomitant fractures, and help in the preoperative planning. 5,8,18,19,22 In our case, the diagnosis was set by the true lateral view.…”

Section: Discussionmentioning

confidence: 99%

“…5 In multiple joint dislocations, some authors accentuate the role of fixation of the third CMC joint (keystone) to aid the reduction and stabilization of the subsequent neighboring joints. 9 The CMC joint capsule should be sutured back for improved stability. 9 In recent years, dorsal buttress plating has provided good results especially in the case of comminuted CMC joint fracture dislocations.…”

Section: Discussionmentioning

confidence: 99%

“…8 Dorsal dislocations are commoner as the stronger static restraints (dorsal ligaments) and dynamic stabilizers (wrist extensors) cause the failure of bone dorsally, followed by rupture of the volar ligaments. 9 The 2nd and 3rd metacarpals form a rigid central unit fixed to the carpus, providing a rotation center around which the mobile thumb and moderately mobile 4th and 5th metacarpals move, providing spatial adaptation for the palm. The key of the 4th and 5th metacarpal mobility is the “saddle joint” configuration between their base and the hamate.…”

Section: Discussionmentioning

confidence: 99%

“…8 13 14 15 The most common causes are a blow with clenched fist (about half of the patients in three case series in literature), a fall from height, and car and motorcycle accidents. 2 5 9 16…”

Section: Discussionmentioning

confidence: 99%

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Delayed Diagnosis of Dislocation of All Four Ulnar Carpometacarpal Joints. Surgical Treatment Strategy and Challenges.

et al. 2023

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Background Carpometacarpal dislocations are rare injuries whose diagnosis is often missed initially. These injuries can be treated conservatively, as long as an anatomical closed reduction is achieved. However, in most cases, open reduction followed by internal or external fixation is necessary to reach a stable anatomical reduction. Case Description A 32-year-old male was referred to our institution due to excess swelling of his right hand, 2 months after a motorcycle crash he sustained. During our imaging workup, a dorsal carpometacarpal dislocation of all four ulnar metacarpals was found accompanied by a fracture of the base of the fifth metacarpal. An open reduction was achieved using Kirschner wires and a small plate for arthrodesis of the fifth carpometacarpal joint. The postoperative follow-up on the 3rd, 6th, and 12th month was uncomplicated. The range of motion and grip strength was satisfactory on the 3rd month and almost full on the 6th month compared to the unaffected side. Literature Review Carpometacarpal dislocations are rare hand injuries. They are often the result of a high-energy injury and their diagnosis is usually delayed or missed. The main reasons are the excessive pain and swelling of the hand which make the initial clinical examination difficult and the overlapping of the metacarpals on the X-ray, which make the radiological diagnosis challenging. Case Relevance A delayed diagnosis needs urgent open surgical treatment to achieve an anatomical reduction due to the interposition of soft tissue, bony fragments, and newly formed callus. Diagnosis and treatment of these injuries demands a high clinical suspicion from the traumatologist. The role of computed tomography scan is invaluable and open reduction is the mainstay of treatment for the cases that are diagnosed late.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 3 more Smart Citations

Delayed Diagnosis of Dislocation of All Four Ulnar Carpometacarpal Joints. Surgical Treatment Strategy and Challenges.

et al. 2023

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Acute Osseous Trauma to the Hand

Buchan,

Sivakumar,

Graham

et al. 2023

Musculoskeletal Imaging

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Hemi-hamate donor site morbidity and complications: a systematic review

et al. 2022

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Background The hemi-hamate arthroplasty is utilised for the management of complex fracture-dislocations for injuries of the proximal interphalangeal joints (PIPJ) of the fingers. PIPJ outcomes are well described, including the post-operative range of motion, grip strength and osteochondral graft union. However, there is a paucity of evidence analysing the rate of donor site morbidity and complications. This systematic review aims to present the published morbidity of the donor site for the hemi-hamate arthroplasty. Methods A search was conducted in MEDLINE, Embase, Emcare, CINAHL and ProQuest Nursing and Allied Health databases from their inception which yielded 384 articles to be screened. Pertinent anatomy, harvesting techniques and post-operative donor site care of the hemi-hamate arthroplasty is reviewed. Results One hundred three cases of hemi-hamate arthroplasty were included in this review with seven (6.8%) complications presented, one of which required operative intervention. Conclusion Donor site morbidity resulting from harvesting an osteochondral graft for a hemi-hamate arthroplasty is low. The overall quality of evidence from the studies in this review is low, highlighting the need for further robust prospective trials. Level of evidence Not gradable.

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Fracture dislocations of the carpometacarpal joints of the fingers

Cited by 13 publications

References 51 publications

Delayed Diagnosis of Dislocation of All Four Ulnar Carpometacarpal Joints. Surgical Treatment Strategy and Challenges.

Delayed Diagnosis of Dislocation of All Four Ulnar Carpometacarpal Joints. Surgical Treatment Strategy and Challenges.

Acute Osseous Trauma to the Hand

Hemi-hamate donor site morbidity and complications: a systematic review

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