gms | German Medical Science

14th Triennial Congress of the International Federation of Societies for Surgery of the Hand (IFSSH), 11th Triennial Congress of the International Federation of Societies for Hand Therapy (IFSHT)

17.06. - 21.06.2019, Berlin

Outcome of partial excision arthoplasty of fifth carpometacarpal joint

Meeting Abstract

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  • presenting/speaker Michelle Spiteri - Nuffield Orthopaedic Centre, Oxford, United Kingdom

International Federation of Societies for Surgery of the Hand. International Federation of Societies for Hand Therapy. 14th Triennial Congress of the International Federation of Societies for Surgery of the Hand (IFSSH), 11th Triennial Congress of the International Federation of Societies for Hand Therapy (IFSHT), 11th Triennial Congress of the International Federation of Societies for Hand Therapy (IFSHT). Berlin, 17.-21.06.2019. Düsseldorf: German Medical Science GMS Publishing House; 2020. DocIFSSH19-447

doi: 10.3205/19ifssh0781, urn:nbn:de:0183-19ifssh07815

Published: February 6, 2020

© 2020 Spiteri.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.


Outline

Text

Objectives/Interrogation: Comminuted intra-articular fractures of the base of the fifth metacarpal without carpometacarpal joint dislocation are relatively common injuries. A small proportion of these injuries develop displacement of a bony fragment due to the pull of extensor carpi ulnaris tendon resulting in an intra-articular step, subsequently remaining symptomatic, with pain, weak grip and subsequent inability to return to their previous level of activity at work.

To assess outcome and function in patients who underwent partial excision arthroplasty of the fifth carpometcarpal joint (CMC) with excision of this bone fragment and interposition of a distally based capsular flap.

Methods: Ten patients were identified prospectively. Wrist range of motion and grip strength were assessed pre-operatively, and at six weeks, six months and one year post-operatively. Pre and post-operative pain visual analogue score (VAS), post-operative patient evaluation measure (PEM) score, and return to work were also assessed.

Results and Conclusions: All patients had delayed presentations, between four and six weeks following injury, and involved the dominant hand. Seven were manual workers, three were military personnel. None had fifth CMC joint dislocation or other injuries on computed tomography scan. Wrist dorsiflexion and ulnar deviation were decreased pre-operatively due to pain and returned to normal when compared to the contralateral side within six weeks of surgery. Mean grip strength was 40% of the contralateral side pre-operatively and improved to 68% by six weeks post-operatively and 87% at six months. Mean pain VAS decreased from 8.4 to 3.4 at six weeks post-operative. Mean PEM score was 19.4 six months after surgery. All patients returned to their previous employment, and none required further surgery. There was no significant further improvement at one year and manual workers described discomfort after a full day at work, which they described as minimal when compared to pre-operative level of pain.

Partial excision arthroplasty of the displaced bone fragment to restore articular congruency of the fifth CMC joint and capsular interposition in cases of delayed presentation or fracture fragment displacement provides good pain relief and improved function allowing return to function and gainful employment.