Artikel
Ulnar carpometacarpal dislocations and fracture-dislocations. Surgery may not be always required
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Autoren
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Isidro Jiménez
- Hospital Universitario Insular de Gran Canaria, Las Palmas de Gran Canaria, Spain
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Juan Sánchez-Hernández
- Hospital Universitario Insular de Gran Canaria, Las Palmas de Gran Canaria, Spain
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Dimosthenis Kiimetoglou
- Hospital Universitario Insular de Gran Canaria, Las Palmas de Gran Canaria, Spain
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Gustavo Muratore
- Hospital Universitario Insular de Gran Canaria, Las Palmas de Gran Canaria, Spain
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Jonathan Caballero
- Hospital Universitario Insular de Gran Canaria, Las Palmas de Gran Canaria, Spain
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José Medina
- Hospital Universitario Insular de Gran Canaria, Las Palmas de Gran Canaria, Spain
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Alberto Marcos-García
- Hospital Universitario Insular de Gran Canaria, Las Palmas de Gran Canaria, Spain
| Veröffentlicht: | 6. Februar 2020 |
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Gliederung
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Objectives/Interrogation: Carpometacarpal (CMC) joint dislocations and fracture-dislocations are uncommon injuries and, initially, they may be often overlooked because of the diffuse hand swelling and misinterpretation of subtle radiographic features as normal. Surgical stabilization is recommended by most authors in order to prevent a secondary dislocation assuming that these injuries are inherently unstable. We hypothesized that when the diagnosis is early and a closed concentric and initially stable reduction is achieved, the surgical treatment may be unnecessary.
Methods: Prospective series of five consecutive cases. In all cases, a closed reduction was performed by traction after an ulnar nerve block of the at the wrist level. Joint stability was assessed by active motion of the wrist and metacarpo-phalangeal joints by the patient. An ulnar splint leaving the MP joint free + buddy-tape was placed in 3 cases and a cast + buddy-tape was used in two. Demographic data, immobilization time, time until reincorporation to previous activities, range of motion, pain and DASH questionnaire were registered.
Results and Conclusions: Five males. Average age of 24 (range, 20-28) years. Minimum follow-up was 12 months. Pure CMC joint dislocation of 4th and 5th radius in 2 cases and fracture-dislocations in 3. In all cases a concentric and stable reduction was achieved. Splint was maintained for 4 weeks and active motion started immediately. No physical therapy was required in any case. Time to reincorporation to previous activities was 11 (range 8-13) weeks. At final follow-up the ROM was complete with pulp-to-palm distance of 0mm in all cases; VAS for pain was 0 at rest, 0 in daily-life activities and 1.6 in physical effort activities; and DASH score was 2.27 (range 0-4.5) points.
We believe that, if the diagnosis of CMC joint dislocation is early and a closed, concentric and stable reduction is initially achieved, the conservative treatment may be a good choice obtaining good functional results and a quick recovery.
