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Carpalmetacarpal Fractures: A New Classification to Direct Outcomes
Safi Faruqui, DO1; Christopher Hogan, MD2
1TriHealth Hand Surgery Specialists, Cincinnati, OH; 2Naval Medical Center Portsmouth, Portsmouth, VA

Hypothesis
Our aims were to evaluate treatment of carpometacarpal (CMC) fracture-dislocations in our military population and create a clinically relevant classification system based upon injury radiographs to assist in guiding treatment. We hypothesized that the incidence of these injuries is higher than previously reported and that operative fixation would provide excellent results.

Methods
A retrospective chart review identified 205 patients with CMC base fracture-dislocations. Data collected included demographics, nicotine use, mechanism of injury, injury patterns, method of fixation, time to union, and postoperative complications. Statistical analysis was performed to compare healing times with the different treatment methodologies and patient factors that could affect healing.

Results
A total of 205 CMC fracture/dislocations were identified that met inclusion criteria. Radiographic review revealed that three patterns of injury could be delineated. Type 1 injuries were unstable CMC dislocations without an intra-articular fracture that often occurred with an extra-articular 4th metacarpal base fracture. Type 2 injuries demonstrated a partial intra-articular fracture of the CMC joint - either of the metacarpal or hamate - with or without dislocation. Type 3 injuries involved fracture of one or both sides of the entire CMC joint surface (pilon equivalent) with or without dislocation. 23/25 the Type 1 injuries and 90/104 of the Type 2 fracture/dislocations were successfully treated with closed reduction and percutaneous pin fixation. 31/76 Type 3 fractures were able to be treated in the same fashion, with the remainder requiring open reduction to restore articular congruity. Radiographic union was achieved on average in 6.9 weeks in 91 percent of fractures. All patients with the exception of one were retained for active military duty or returned to their prior activity level. There were no statistical differences as far as fracture union based upon age, gender, nicotine use, mechanism of injury, or injury pattern.

Summary Points

  • Carpometacarpal base fracture dislocations are common injuries in the active duty military population
  • These injuries are frequently unstable and require internal fixation to maintain a congruent reduction of the CMC joint
  • Using the proposed classification system, it is possible to use the injury radiographs to assist in determining operative approach and direct treatments, obtain excellent radiographic healing rates, and return nearly all patients to previous activity levels.

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