J Korean Fract Soc.  2011 Jul;24(3):249-255.

Operative Treatment in the Delayed Diagnosed Fracture and Dislocation of Hamatometacarpal Joint

• Lee SH
• Park JW
• Kim JI
• Lee SJ

Abstract

PURPOSE
The purpose is to evaluate and report the results that treated with open reduction and internal fixation in delayed diagnosed fracture and dislocation of the hamatometacarpal joint.
MATERIALS AND METHODS
We evaluated 12 cases that had been treated with open reduction and internal fixation in delayed diagnosed fracture and dislocation of the hamatometacarpal joint. The mean interval between injury and operation was 34 days (21~60 days), the mean age of 12 cases was 28.1 years old, and mean follow-up period was 18 months. The computer tomography was done in all cases and the fracture and dislocation types were classified by Cain's classification. For the evaluation of results, pain scale, grasping power, range of motion of wrist and metacarpophalangeal joint were analyzed preoperatively and at final follow up, and the arthritic change of the hamatometacarpal joint was also checked.
RESULTS
According to Cain's classification, type Ia was one case, type Ib was two, type II was six, and type III was three. The pain scale was improved from 7.75 preoperatively to 0.92 at last follow up. The mean grasping power was improved up to 97.5% of normal. The preoperative range of motion of the wrist joint measured to be 60 degrees in extension and 70 degrees in flexion; the final range of motion indicated to be 75 degrees in extension and 80 degrees in flexion. The preoperative range of motion of the metacarpophalangeal joint measured to be 0 degrees in extension and 70 degrees in flexion; the final range of motion indicated to be 0 degrees in extension and 85 degrees in flexion. Carpometacarpal arthritis was developed in two cases.
CONCLUSION
The open reduction and internal fixation is considered as one of good treatment option in the delayed diagnosed hamatometacarpal fracture and dislocation.

Keyword

Hamatometacarpal joint; Fracture and dislocation; Open reduction and internal fixation

MeSH Terms

Arthritis
Dislocations
Follow-Up Studies
Hand Strength
Joints
Metacarpophalangeal Joint
Range of Motion, Articular
Wrist
Wrist Joint

Figure

• 

  Fig. 1 Cain classification3).

• 

  Fig. 2 AP and lateral radiographs (A, B) and CT (C) scan show a fracture and dislocation of Cain's type II. AP and lateral radiographs (D, E) following operation of dorsal hamate fracture with 2.0 mm miniscrew and additional K-wire.

• 

  Fig. 3 AP and lateral radiographs (A, B) and CT (C) scan depicting a missed hamatometacarpal joint fracture and dislocation 30 days postinjury. AP and lateral radiographs (D, E) after operation. Final radiographs (F, G) show arthrosis at 4, 5th CMC joint.

• 

  Fig. 4 AP and lateral radiographs (A, B) and CT (C) scan depicting a missed hamatometacarpal joint fracture and dislocation 25 days postinjury.

Reference

1. Black DM, Watson HK, Vender MI. Arthroplasty of the ulnar carpometacarpal joints. J Hand Surg Am. 1987. 12:1071–1074.

2. Bora FW Jr, Didizian NH. The treatment of injuries to the carpometacarpal joint of the little finger. J Bone Joint Surg Am. 1974. 56:1459–1463.

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

4. Chase JM, Light TR, Benson LS. Coronal fracture of the hamate body. Am J Orthop (Belle Mead NJ). 1997. 26:568–571.

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

6. de Beer JD, Maloon S, Anderson P, Jones G, Singer M. Multiple carpo-metacarpal dislocation. J Hand Surg Br. 1989. 14:105–108.

7. Ebraheim NA, Skie MC, Savolaine ER, Jackson WT. Coronal fracture of the body of the hamate. J Trauma. 1995. 38:169–174.

8. 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.

9. Fakih RR, Fraser AM, Pimpalnerkar AL. Hamate fracture with dislocation of the ring and little finger metacarpals. J Hand Surg Br. 1998. 23:96–97.

10. Gainor BJ, Stark HH, Ashworth CR, Zemel NP, Rickard TA. Tendon arthroplasty of the fifth carpometacarpal joint of treatment of posttraumatic arthritis. J Hand Surg Am. 1991. 16:520–524.

11. Green WL, Kilgore ES Jr. Treatment of fifth digit carpometacarpal arthritis with Silastic prosthesis. J Hand Surg Am. 1981. 6:510–514.

12. Hartwig RH, Louis DS. Multiple carpometacarpal dislocation. A review of four cases. J Bone Joint Surg Am. 1979. 61:906–908.

13. Henderson JJ, Arafa MA. Carpometacarpal dislocation. An easily missed diagnosis. J Bone Joint Surg Br. 1987. 69:212–214.

14. Hunt TR 3rd. Degenerative and post-traumatic arthritis affecting the carpometacarpal joints of the fingers. Hand Clin. 2006. 22:221–228.

15. Imbriglia JE. Chronic dorsal carpometacarpal dislocation of the index, middle, ring, and little fingers: a case report. J Hand Surg Am. 1979. 4:343–345.

16. Jeon SJ, Yoon HK, Jung KW, Lee YJ, Noh KS. Closed reduction and percutaneous pinning in fracture-dislocations of Carpometacarpal Joints. J Korean Orthop Assoc. 2001. 36:199–206.

17. Kellgren JH, Lawrence JS. Radiological assessment of osteo-arthrosis. Ann Rheum Dis. 1957. 16:494–502.

18. 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.

19. Mueller JJ. Carpometacarpal dislocation: report of five cases and review of the literature. J Hand Surg Am. 1986. 11:184–188.

20. 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.