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Carpometacarpal Dislocation Classification System for Treatment and Prognosis
Emily Nuse, MD; Nicholas Noce, MD; John Rawlings, MD; Madigan Army Medical Center
Madigan Army Medical Center, Tacoma, WA, USA

INTRODUCTION: Carpometacarpal dislocations are rare but potentially debilitating injuries. Chronic pain, loss of range of motion, and decreased grip strength have been described in conjunction with these dislocations. There are currently no guidelines for treatment or indications for prognosis in terms of type of carpometacarpal dislocation.

MATERIALS & METHODS: A retrospective review was performed of the electronic medical record of all patients treated between 2004-2011 by the orthopaedic surgery service at our institution. Patients were classified in terms of associated radiographic findings and subsequent treatments were identified. Outcomes were measured in terms of grip strength and range of motion.

RESULTS: Fifty patients were identified with an average follow-up of 134 days after initial treatment. Four distinct types of carpometacarpal dislocations were identified: fracture of metacarpal with other metacarpal dislocation(s), fracture/dislocation of same metacarpal base(s), avulsion fracture(s) with dislocation(s), dislocation(s) without fracture. Sixty percent of avulsion fracture(s) were stable with cast treatment, with 20% of fracture/dislocation of same metacarpal(s) stable with cast treatment. Avulsion fracture(s) with dislocation(s) had 90% return of full range of motion, with only 53% of fracture/dislocation(s) obtaining full range of motion. Fracture of metacarpal with other metacarpal dislocation(s) had the lowest grip strength with 69% of the contralateral hand, dislocation(s) without fracture had the highest grip strength with 92% of the contralateral hand.

DISCUSSION: A classification system for carpometacarpal dislocations can assist with treatment decisions as well as determining prognosis for this patient population. Dislocations with associated fracture of either the same dislocated metacarpal or a non-dislocated metacarpal were more unstable in our patient population, with more patients failing closed reduction and cast treatment. These patients also had worse outcomes in terms of range of motion and grip strength.

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