Nonoperative Treatment of Ulnar Carpometacarpal Fracture–DislocationsFunding None.
17 January 2019
25 March 2019
09 May 2019 (eFirst)
Background Ulnar carpometacarpal (CMC) joint dislocations and fracture–dislocations are uncommon injuries that are often overlooked. Most authors advocate surgical stabilization in order to prevent a secondary dislocation assuming that these injuries are inherently unstable.
Case Description This is a series of eight ulnar CMC joint dislocations and fracture–dislocations treated by closed reduction and splint immobilization after assessing the joint stability. Mean follow-up was 30.2 months, and minimum follow-up was 12 months. Satisfactory results were obtained in range of motion, grip strength, pain, DASH (Disabilities of the Arm, Shoulder and Hand) questionnaire, and time to return to working activities. In the same period, the closed reduction and cast failed two (20%) cases that were referred for surgery.
Literature Review There is little published literature on the nonoperative treatment of these injuries. Most of them are isolated case reports, whereas the largest series reports four cases. All of them have reported satisfactory results.
Clinical Relevance Based on our results, we believe that if the diagnosis of an ulnar CMC joint dislocation or fracture–dislocation is early accomplished and a concentric and stable reduction is initially achieved, the nonoperative treatment may be a successful option to take into account but requiring a close follow-up for the first week.
The authors confirm that they have not published the same or a very similar study with the same or very similar results and major conclusions in any other journal.
- 1 Storken G, Bogie R, Jansen EJP. Acute ulnar carpometacarpal dislocations. Can it be treated conservatively? A review of four cases. Hand (N Y) 2011; 6 (04) 420-423
- 2 Day CS, Stern PJ. Fractures of the metacarpals and phalanges. In: Wolfe SW, Hotchkiss RN, Pederson WC, Kozin SH. , eds. Green's Operative Hand Surgery. 6th ed. Philadelphia, PA: Elsevier Churchill Livingstone; 2011: 239-290
- 3 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
- 4 Garcia-Elias M, Bishop AT, Dobyns JH, Cooney WP, Linscheid RL. Transcarpal carpometacarpal dislocations, excluding the thumb. J Hand Surg Am 1990; 15 (04) 531-540
- 5 Yoshida R, Shah MA, Patterson RM, Buford Jr WL, Knighten J, Viegas SF. Anatomy and pathomechanics of ring and small finger carpometacarpal joint injuries. J Hand Surg Am 2003; 28 (06) 1035-1043
- 6 Gangloff D, Mansat P, Gaston A, Apredoaei C, Rongières M. Carpometacarpal dislocation of the fifth finger: descriptive study of 31 cases [in French]. Chir Main 2007; 26 (4-5): 206-213
- 7 Frick L, Mezzadri G, Yzem I, Plotard F, Herzberg G. Acute carpometacarpal joint dislocation of the long fingers: study of 100 cases. [in French ]. Chir Main 2011; 30 (05) 333-339
- 8 Jumeau H, Lechien P, Dupriez F. Conservative treatment of carpometacarpal dislocation of the three last fingers. Case Rep Emerg Med 2016; 2016: 4962021
- 9 Anjum R, Roy A, Farooque K, Sharma V. An isolated pure dislocation of fifth carpometacarpal joint: case report and review of literature. J Orthop Case Rep 2017; 7 (02) 14-16
- 10 Beekhuizen S, de Witte PB, Rutgers M, Ohanis D. Isolated ulnopalmar dislocation of the fifth carpometacarpal joint. BMJ Case Rep 2018; pii: bcr-2018–225363