gms | German Medical Science

Objectives/Interrogation: The chronic dislocation without fracture is very rare, acute event is less than 1% of hand injuries, and literature does not report cases of chronic dislocation or instability with the cartilage intact. We described two cases and proposed a surgical technique with clinically evaluation.

Methods: A retrospective series of cases study who underwent a ligament reconstruction with the proposed technique. We evaluated pain (VAS), passive and active movement with goniometer, injured and contralateral hand strength with dynamometer, and surgical procedure satisfaction.

Surgical Technique: Dorsal curvilinear incision is made over the fifth carpometacarpal joint. Release interposed fibrosis, then fix the fifth metacarpal to the hamatal, and the forth metacarpal with kirschner wires. The radial hemi tendon of the ECU is taken, with a drill perform a tunnel in the fourth metacarpal between the metaphysis and the shaft, the tendon is directed from ulnar to dorsal, then placed below the insertion of the ECU, and sutured with periosteum or anchored suture over the hamatal.

Results and Conclusions: Two male patients, with 31.5 years of average age, 5.5 months evolution prior surgery, VAS pain 10. One year of POP follow up. Wrist: Flexion: 40 ° and extension 45 °. Pinch straight 8 kg and grasp force 19 kg; 82.5% and 73.3% comparative grip and pinch force. Averaged pain at rest 0 and 1.5 with activity. All patients were satisfied, and no complications reported.

There is no treatment in the literature for the chronic injury with undamaged cartilage. The ligament reconstruction tries to restore the anatomy and also maintains the alignment of the joint allowing stability in this mobile joint, does not restrict movement, does not alter the function of the ECU, have good comparative hand function and does not rule out the use of other surgical procedures in patients in whom the described technique fails.