Operative Treatment in the Delayed Diagnosed Fracture and Dislocation of Hamatometacarpal Joint

Suk Ha Lee; Jong Wong Park; Jin Il Kim; Seoung Joon Lee

doi:10.12671/jkfs.2011.24.3.249

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Lee, Park, Kim, and Lee: Operative Treatment in the Delayed Diagnosed Fracture and Dislocation of Hamatometacarpal Joint

Original Article

Journal of the Korean Fracture Society

Journal of the Korean Fracture Society 2011; 24(3): 249-255.

Published online: 15 July 2011

DOI: https://doi.org/10.12671/jkfs.2011.24.3.249

Operative Treatment in the Delayed Diagnosed Fracture and Dislocation of Hamatometacarpal Joint

Suk Ha Lee, M.D., Jong Wong Park, M.D.^*, Jin Il Kim, M.D., Seoung Joon Lee, M.D.

Department of Orthopedic Surgery, School of Medicine, Konkuk University, Seoul, Korea.

^*Department of Orthopedic Surgery, School of Medicine, Korea University, Seoul, Korea.

Address reprint requests to: Seoung Joon Lee, M.D. Department of Orthopaedic Surgery, Konkuk University School of Medicine, Hwayang-dong, Gwangjin-gu, Seoul 143-701, Korea. Tel: 82-2-2030-7360, Fax: 82-2-2030-7369, lsjmd@kku.ac.kr

Received 19 May 2010 Revised 6 March 2011 Accepted 14 March 2011

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

The purpose is to evaluate and report the results that treated with open reduction and internal fixation in delayed diagnosed fracture and dislocation of the hamatometacarpal joint.

Materials and Methods

We evaluated 12 cases that had been treated with open reduction and internal fixation in delayed diagnosed fracture and dislocation of the hamatometacarpal joint. The mean interval between injury and operation was 34 days (21~60 days), the mean age of 12 cases was 28.1 years old, and mean follow-up period was 18 months. The computer tomography was done in all cases and the fracture and dislocation types were classified by Cain's classification. For the evaluation of results, pain scale, grasping power, range of motion of wrist and metacarpophalangeal joint were analyzed preoperatively and at final follow up, and the arthritic change of the hamatometacarpal joint was also checked.

Results

According to Cain's classification, type Ia was one case, type Ib was two, type II was six, and type III was three. The pain scale was improved from 7.75 preoperatively to 0.92 at last follow up. The mean grasping power was improved up to 97.5% of normal. The preoperative range of motion of the wrist joint measured to be 60 degrees in extension and 70 degrees in flexion; the final range of motion indicated to be 75 degrees in extension and 80 degrees in flexion. The preoperative range of motion of the metacarpophalangeal joint measured to be 0 degrees in extension and 70 degrees in flexion; the final range of motion indicated to be 0 degrees in extension and 85 degrees in flexion. Carpometacarpal arthritis was developed in two cases.

Conclusion

The open reduction and internal fixation is considered as one of good treatment option in the delayed diagnosed hamatometacarpal fracture and dislocation.

Keywords: Hamatometacarpal joint, Fracture and dislocation, Open reduction and internal fixation

Figures and Tables

Fig. 1

Cain classification3).

Fig. 2

AP and lateral radiographs (A, B) and CT (C) scan show a fracture and dislocation of Cain's type II. AP and lateral radiographs (D, E) following operation of dorsal hamate fracture with 2.0 mm miniscrew and additional K-wire.

Fig. 3

AP and lateral radiographs (A, B) and CT (C) scan depicting a missed hamatometacarpal joint fracture and dislocation 30 days postinjury. AP and lateral radiographs (D, E) after operation. Final radiographs (F, G) show arthrosis at 4, 5th CMC joint.

Fig. 4

AP and lateral radiographs (A, B) and CT (C) scan depicting a missed hamatometacarpal joint fracture and dislocation 25 days postinjury.

Table 1

Details of the patient

Table 2

Results of the last follow-up

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