Management algorithm for index through small finger carpometacarpal fracture dislocations.

PURPOSE: Injuries to the carpometacarpal (CMC) joints are rare. The most common CMC fracture dislocations occur in the ring and small finger CMC joints. The aim of this study was to review the structured diagnostic procedure and different treatment options.

METHODS: We review the importance of early and correct diagnosis in CMC fracture dislocation, because it is needed to ensure pain-free hand function. Moreover, we contrast different therapeutic options, including non-operative and surgical therapy for CMC fracture dislocation.

RESULTS: If a clinical suspicion for a CMC dislocation based on patient examination or radiographic findings exists, then a thin slice CT should be considered. Non-operative treatment is rarely indicated. Surgical treatment may include closed or open reduction efforts. In the case of most fracture dislocations, open reduction is recommended. Fracture fixation may be accomplished with K-wires, mini plates or screws.

CONCLUSION: CMC fracture dislocations of the fourth and fifth CMC joints are uncommon and often overlooked. Primary goal of treatment is to restore normal function to the hand. Therefore, operative therapy might be the method of choice.