[Acute carpometacarpal joint dislocation of the long fingers: study of 100 cases]

L Frick, G Mezzadri, I Yzem, F Plotard, G Herzberg
Chirurgie de la Main 2011, 30 (5): 333-9

OBJECTIVES: The authors report clinical and radiological results of carpometacarpal dislocations treated in emergency over a period of 7 years (2002-2009). Mechanisms of injury and diagnosis pitfalls are specified, and treatment options are discussed.

METHODS: A retrospective study of 100 carpometacarpal dislocations was performed. Most commonly trauma was a punch (56%). In half the cases, lesions were located only within the fifth ray. Carpal or metacarpal fractures were associated in a majority of cases (88%). Surgical treatment was carried out in all cases either by closed reduction and percutaneous pinning (60%), or by open reduction and internal fixation (40%). The mean follow-up was 5 months. Anatomic reduction of dislocation, consolidation and reduction of associated fractures were analysed on the last follow-up x-rays. Evaluation tools were pain score, range of motion and grip strength.

RESULTS: Radiological criteria were satisfactory in 68% of cases. Non-satisfactory X ray criteria were mainly associated with closed reduction and percutaneous pinning. At final follow up, 81% of the patients were pain-free and had recovered complete range of motion. In 16% of patients pain was only found during grip strength test.

CONCLUSIONS: Carpometacarpal luxations are not as rare as suggested by literature. Early diagnosis and treatment are essential for the prognosis. Increasing indications of a scan enable better analysis by identifying all injuries. Open reduction by which allows the treatment of all associated injuries must be promoted.

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