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Outcomes of Operatively Treated 4th and 5th CMC Fracture-Dislocations
Lindsay R Kosinski, MD
1; Alexander Lauder, MD
2; Matthew Folchert, MD
31University of Colorado School of Medicine, Aurora, CO; 2University of Colorado Anschutz Medical Campus, Aurora, CO; 3Denver Health Medical Center, Denver, CO
Purpose: Outcomes following surgical treatment of 4
th and 5
th carpometacarpal (CMC) fracture-dislocations are underreported and few studies describe the implications of concomitant hamate fractures on patient outcomes. This study described the clinical and radiographic outcomes of surgically treated 4
th and 5
th CMC fracture-dislocations. We hypothesized that injuries treated in a delayed fashion and those with hamate fractures would have worse outcomes.
Methods: A retrospective review identified patients with 4
th and 5
th CMC fracture-dislocations treated surgically at a single institution. Demographics, clinical, radiographic, and patient reported outcomes (PROs) were assessed using descriptive statistics.
Results: Twenty-one patients were included (19 male, 2 female; average age 34 years). Most patients injured their dominant hand (71%, n=15) with blunt trauma from punching. 52% (n=11) sustained an associated hamate fracture. 43% (n=9) underwent surgery within 10 days of injury, and 81% (n=17) within 21 days. Treatment included closed reduction with percutaneous pinning or open reduction and fixation with K-wires, screws, plates, and/or suture anchors. Mean follow up was 82 days (range 33-127). At final follow up, 95% (n=20) had full wrist motion. 62% (n=13) had composite digit motion 0cm from the distal palmar crease (DPC), 14% (n=3) 0-1cm from the DPC, and 24% (n=5) >1cm from the DPC. 42% (n=9) demonstrated an extensor lag at the ring and/or small finger. 33% (n=7) demonstrated arthrosis at final follow-up. Of these, 57% (4 of 7) had an associated hamate fracture or delay to surgery >10 days from injury. PROs are outlined in Table 1. The complication rate was 24% (n=5): two surgical site infections, one recurrent subluxation, one loss of reduction, and one small finger extension contracture. The reoperation rate was 14% (n=3): one for surgical site infection, one for k-wire removal, and one for revision reduction with hamate fracture fixation.
Summary: Surgical treatment of 4
th and 5
th CMC fracture-dislocations demonstrated a high rate of radiographic arthrosis despite reasonable clinical and PROs. The complication rate approached 25% with 14% requiring re-operation. Fixation failure was attributed to lack of hamate fracture-specific fixation. Cases with associated hamate fractures demonstrated increased extensor lag and worse digit motion.
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