gms | German Medical Science

Objectives/Interrogation: Management of ulnar sided CMC fracture dislocations by means of ligamentotaxis provided through miniature spanning external fixation stabilization with precise but limited intra-articular fragment realignment and fixation with K wires can provide restoration of articular architecture and digital alignment while allowing early return to function followed by durable, positive patient reported outcomes.

Methods: 10 patients (eight men, two women) received acute surgical repair of ulnar-sided CMC fracture dislocations with intra-articular comminution using K-wires & spanning miniature external fixators. Follow-up was ranged 1-8 years, average.3.4 years. All radiographs were reviewed and evaluated by two independent reviewers. Patients were asked to rate their level of pain, answer a series of patient perceived outcomes questions using the Quick DASH subjective outcome instrument for functional assessment.

Results and Conclusions: There were no major complications. There were 2 transient pin tract infections which resolved with oral antibiotics; no nerve or tendon injuries. All implants were removed in the clinic without need for additional surgery. All hands healed primarily with maintenance of a congruent joint space without radiographic evidence of displacement or subsequent arthrosis. Patient satisfaction was high and function was near normal with minimal if any pain (average 1.2 on VAS scale). All patient's felt they had returned to pre-injury hand function status.

Ulnar-sided CMC fracture dislocation tendons to be an injury sustained by young males most frequently during an argument or moment of rage. Despite a potential for noncompliance in this group. Biomechanically advantageous augmented external fixation has promoted early return to function, minimal disability with maintenance of early motion and functional activities of daily living. Patients have been compliant in careful pin site care, returning for follow-up and especially fixator removal. As such we have found this surgical technique preferable to K wire fixation alone with casting. Our surgical technique with rehabilitation protocol will be presented.