Carpometacarpal Fracture-dislocations
Condition: Carpometacarpal; Dislocation
MeSH terms: Joint Dislocations; Fracture Dislocation
Study type: Observational

Summary: 
      Fracture-dislocation of the carpometacarpal (CMC) joints of the ring and little finger are
      the most affected CMC joints and the dislocation may be accompanied by other hand injuries.
      Fracture-dislocation of the CMC joints of the ring and little finger are extremely mobile
      because of their saddle shape anatomy and loose ligamentous attachments. Missed and incorrect
      diagnosis is very frequent in metacarpal base injuries of the hand and results in impaired
      function and weak grip. In these lesions immediate reduction is imperative. Treatment options
      for these injuries include non-operative management, closed reduction with Kirschner wire
      fixation (K-wire) and open reduction with internal fixation (ORIF). In chronic CMC
      fracture-dislocations ORIF is mandatory. Although operative treatment is recommended in the
      literature in fracture-dislocation of the CMC joints of the ring and little finger, other
      authors, in specific cases, performed conservative treatment through immediate reduction and
      splint immobilization and this treatment can be sufficient.
    

Detailed description: 
      Physical examination in carpometacarpal injuries reveals ulnar-sided pain, swelling, diffuse
      edema, a palpable lump and tenderness of the hand.

      Radiological examination include hand-wrist radiographs in the posteroanterior (PA), true
      lateral and 45º oblique views. A true lateral view of the hand may demonstrate the
      dislocation, although overlapping of the joints can mask the dislocation. On PA radiographs,
      Fisher et al. propose using the so-called M-line parallelism of the CMC joints. A break in
      this M-line suggests a dislocation. Another method is to draw metacarpal cascade lines on a
      PA radiographs.

      It is important to recognise the associate lesions, for example hamate fractures, because
      this fracture can change the prognosis, surgical planning and treatment. The investigators
      hypothesized that there is an interobserver variability to evaluate the carpometacarpal
      fracture-dislocation and associated lesions in x-rays are underestimated. The investigators
      propose a protocol with a CT scan to asses this lesions. The researchers hypothesised that
      surgical reconstruction would result in better clinical result and lower complications rate
      than non-surgical treatment.
    

Intervention name(s): Osteosynthesis
Intervention type(s): Procedure
Intervention description(s): Reduction and fixation of the carpometacarpal fracture dislocation of the hand with osteosynthesis (Kirschners wires, plate and screws)
Other intervention name(s): Cast
Observational model: Case-Only
Time perspective: Retrospective
Sampling method: Non-Probability Sample
Study population: 
        The patients are adults with a closed injury in their hand. For clinical, x-ray and TC we
        evaluated the carpometacarpal fracture dislocation of the hand and associated lesions.