J Korean Fract Soc.  2011 Jan;24(1):60-66. 10.12671/jkfs.2011.24.1.60.

Comparison of Early Fixation and Late Fusion of 4, 5th Carpometacarpal Joint in the Intra-Articular Fractures of 4th and 5th Metacarpal Base

• Yi CH
• Oh JR

• KMID: 1449418
• DOI: http://doi.org/10.12671/jkfs.2011.24.1.60

Abstract

PURPOSE
To evaluate clinical results between early fixation group and delayed fusion group in treatment of intraarticular fracture of 4th, 5th metacarpal base.
MATERIALS AND METHODS
From March 2002 to December 2006, 21 cases of early fusion and 11 cases of delayed fusion of 4, 5th carpometacarpal joint were reviewed retrospectively or were included in this study. Average follow up period is 39.9 months. Bony union was checked by plain films at follow up. DASH-questionnaire, VAS pain scale, grip power and range of motion of 4th, 5th metacarpophalangeal joint were also checked at last follow up.
RESULTS
In radiologic study, bony union was confirmed in all cases of two groups. Early fixation group showed better outcomes than delayed fusion group in range of motion, DASH-questionnaire and VAS pain scale with statistical significant (p<0.004).
CONCLUSION
Because early fixation group showed better clinical outcomes than delayed fusion group, early diagnosis and proper surgical treatment are important for better outcomes in treatment of intraarticular fracture of 4th, 5th metacarpal base.

Keyword

4th, 5th metacarpal base; Early fixation; Delayed fusion

MeSH Terms

Carpometacarpal Joints
Early Diagnosis
Follow-Up Studies
Hand Strength
Intra-Articular Fractures
Metacarpophalangeal Joint
Range of Motion, Articular
Retrospective Studies

Figure

• 

  Fig. 1 Three-dimensional reconstruction image of computed tomography shows the intraarticular fractures occurred simultaneously in the fourth and fifth metacarpal base.

• 

  Fig. 2 24 year-old patient came with fractures in the fourth and fifth metacarpal base by traffic accident (A). He diagnosed immediately at emergency department, so he was taken surgery at two day after trauma (B). At postoperative 9 months, bony union was confirmed in plain film (C).

• 

  Fig. 3 18 year-old patient came with fractures in the fourth metacarpal base and hamate with dislocation of 4th, 5th carpometacarpal joint by traffic accident (A). For firm fixation of hamate, 4th metacarpal bone and hamate were tied up together by hand mini plate & screws (B). At postoperative 12 months, bony union was confirmed in plain film (C).

• 

  Fig. 4 54 year-old female came to outpatient department complained prolonged pain at the fourth and fifth metacarpal base area after fall down injury 2 months ago (A). Because of non-union, she was taken arthrodesis with autoiliac bone graft with hand-mini plate and screws (B). At postoperative 11 months, fused fourth and fifth carpometacarpal joint was confirmed in plain film (C).

Reference

1. Bushnell BD, Draeger RW, Crosby CG, Bynum DK. Management of intra-articular metacarpal base fractures of the second through fifth metacarpals. J Hand Surg Am. 2008. 33:573–583.

2. Cain JE Jr, Shepler TR, Wilson MR. Hamatometacarpal fracture-dislocation: classification and treatment. J Hand Surg Am. 1987. 12:762–767.

3. Choi JY, Shin HK, Son KM, Ko CS. Operative treatment in fracture-dislocations of carpometacarpal joints. J Korean Fract Soc. 2005. 18:443–451.

4. Clendenin MB, Smith RJ. Fifth metacarpal/hamate arthrodesis for posttraumatic osteoarthritis. J Hand Surg Am. 1984. 9:374–378.

5. El-Shennawy M, Nakamura K, Patterson RM, Viegas SF. Three-dimensional kinematic analysis of the second through fifth carpometacarpal joints. J Hand Surg Am. 2001. 26:1030–1035.

6. Lane CS. Detecting occult fractures of the metacarpal head: the Brewerton view. J Hand Surg Am. 1977. 2:131–133.

7. Liaw Y, Kalnins G, Kirsh G, Meakin I. Combined fourth and fifth metacarpal fracture and fifth carpometacarpal joint dislocation. J Hand Surg Br. 1995. 20:249–252.

8. Lundeen JM, Shin AY. Clinical results of intraarticular fractures of the base of the fifth metacarpal treated by closed reduction and cast immobilization. J Hand Surg Br. 2000. 25:258–261.

9. Niechajev I. Dislocated intra-articular fracture of the base of the fifth metacarpal: a clinical study of 23 patients. Plast Reconstr Surg. 1985. 75:406–410.

10. Petrie PW, Lamb DW. Fracture-subluxation of base of fifth metacarpal. Hand. 1974. 6:82–86.

11. Raven EE, Kerkhoffs GM, Rutten S, Marsman AJ, Marti RK, Albers GH. Long term results of surgical intervention for osteoarthritis of the trapeziometacarpal joint: comparison of resection arthroplasty, trapeziectomy with tendon interposition and trapezio-metacarpal arthrodesis. Int Orthop. 2007. 31:547–554.

12. Schortinghuis J, Klasen HJ. Open reduction and internal fixation of combined fourth and fifth carpometacarpal (fracture) dislocations. J Trauma. 1997. 42:1052–1055.

13. Viegas SF, Crossley M, Marzke M, Wullstein K. The fourth carpometacarpal joint. J Hand Surg Am. 1991. 16:525–533.

14. Yoon SW, Hwang TS, Park BG, Kim SD. Operative treatment of the tibial pilon fractures. J Korean Soc Fract. 1999. 12:621–631.

15. Yoshida R, Shah MA, Patterson RM, Buford WL Jr, Knighten J, Viegas SF. Anatomy and pathomechanics of ring and small finger carpometacarpal joint injuries. J Hand Surg Am. 2003. 28:1035–1043.