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Rate of Clinically Significant Post-traumatic Arthritis following Small Finger CMC Fracture-Dislocations
Min Jung Park, MD, MMSc1; Nick Pappas1; David J. Bozentka, MD2
1Department of Orthopedic Surgery, University of Pennsylvania, Philadelphia, PA; 2Department of Orthopedic Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA

Introduction: Although small finger carpometacarpal (CMC) joint fracture-dislocations are relatively common hand injuries, there are few studies in the orthopaedic literature fousing on their clinical outcomes.  The goal of this study was to analyze the rate of clinically significant post-traumatic arthritis following small finger CMC joint fracture-dislocations treated with either cast immobilization alone or open reduction and internal fixation.

Methods: We performed a retrospective chart review of 91 consecutive patients treated for a small finger CMC fracture-dislocation by a single fellowship-trained hand surgeon over a 5 year period.  Operative indications included irreducible small finger CMC fracture-dislocations and recurrent small finger CMC joint instability after attempted reduction. 

Group I included 72 patients with small finger CMC fracture-dislocations who were treated with cast immobilization alone for 6 weeks, while Group II included 16 patients treated surgically and followed by 6 weeks of cast immobilization.  Clinical outcome parameters included post-treatment serial radiographs, subjective pain scores, and need for subsequent small finger CMC arthrodesis.

Results:  Patients in both groups were followed for a minimum of 12 months.  In Group I (casting alone), 6 of the 72 patients (8.3%) developed clinically significant post-traumatic arthritis and required a subsequent small finger CMC arthrodesis.  In Group II (surgical), none of the patients developed clinically significant post-traumatic arthritis or required an arthrodesis. 

Conclusion: Small finger CMC fracture-dislocations treated with casting alone are more prone to developing post-traumatic arthritis and require subsequent arthrodesis than those treated with open reduction and internal fixation.

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