DOI: http://dx.doi.org/10.18203/issn.2455-4510.IntJResOrthop20180679

Clinical outcomes in management of dislocation of carpometacarpal joints of hand: a rare orthopaedic presentation

Aurobinda Das, Sanket Mishra, Damodar Panda, Sanchaita Misra, Manish Sharma, Deepankar Satapathy, Bibhudutta Mall

Abstract


Background: Dislocation of carpo-metacarpal (CMC) joints especially involving the 2nd and 3rd or paired dislocations, presents a rare pattern of orthopaedics hand injuries. They are associated with high energy trauma usually involving motorbike accidents. Severe soft tissue inflammation over the affected hand and associated injuries often makes detection of these fractures difficult. They require prompt management at presentation. Failure to be diagnosed and treated at early stage leads to joint stiffness, restrictions of wrist movement, deformity and sometimes ruptures of tendons crossing the wrist. Most of them require open reduction and internal fixation for stabilization. The objective of the study was to clinically evaluate outcomes in management of carpometacarpal joint dislocations.

Methods: We prospectively studied 6 cases of CMC dislocation presenting at average of 1week from the original injury. All were clinically and radiologically evaluated. 3 cases were managed with open reduction and internal fixation with K wire and 1with closed manipulation and percutaneous k wire fixation and 1 case by arthrodesis of CMC joint. Functional assessment was done with Quick DASH score at 6 weeks, 3 months, 6 months and 1 year.

Results: All the patients went on to have good functional recovery. The average quick DASH score showed improvement from 77.39 to 4.07 over 1 year follow-up.

Conclusions: Careful and meticulous examinations of hands are necessary in high velocity trauma cases to avoid missing diagnosis of CMC dislocation. ORIF remains the gold standard treatment which can also be used for cases presenting late, followed by aggressive post-op physiotherapy can lead to excellent recovery of hand function.


Keywords


Carpometacarpal, Dorsal, Volar, Quick DASH

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