Operative Treatment of Non-Thumb Carpometacarpal Joint Fracture Dislocations

Abstract

Purpose: To investigate the functional outcomes and complications of operatively managed carpometacarpal (CMC) fracture dislocations, excluding the thumb, in a young, active population. Methods: A retrospective chart review of all patients undergoing surgical treatment for CMC joint injuries at a single institution over a 6-year period was performed. Patients were excluded if they had a first CMC joint injury, were under 18 years old, or had incomplete documentation. Injury radiographs were categorized as simple/extra-articular, partial articular, and complete articular. Electronic health records were searched for demographic information, mechanism, associated injuries, time to surgery, time to union, time to return to full-activity, complications, and need for revision surgery. QuickDASH (Disabilities of Arm, Shoulder, and Hand) and Patient-Reported Wrist Evaluation scores were collected at final follow-up. Results: A total of 160 patients were included in the study, of which 89% were male. Punching was the most common mechanism of injury. Combined fourth and fifth CMC fracture dislocations and isolated fifth CMC fracture dislocations encompassed 90% of the injury patterns seen. Combined fourth and fifth CMC joint injuries had an associated distal carpal row fracture 54% of the time. There was a 29% complication rate. Complications related to K-wires made up 55% of the total complications. Final follow-up was obtained on 45/160 patients (28%). The median final QuickDASH score was 11.4 (range, 0–45.5), with 65% of patients meeting the patient acceptable symptomatic state. Median Patient-Reported Wrist Evaluation score of 18.5 (range, 0–67.5) with 76% meeting the patient acceptable symptomatic state. Among the 133 active-duty military patients included, 79/133 (59%) remained on active-duty at a median of 3.3 years after surgery. Conclusions: Despite relatively high surgical complication rates, operative management of CMC fracture dislocations results in good-to-excellent functional outcomes. Type of study/level of evidence: Differential diagnosis/system prevalence study III.

Keywords

• Carpometacarpal joint
• Hamate fracture
• Metacarpal base fracture