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Abstract
Purpose
To evaluate the classification and treatment results about the injury of carpometacarpal (CMC) joint with the fracture of hamate.
Materials and Methods
The authors categorized into 3 types (I, II, III) according to the location of injured CMC joint and type II was subdivided into 2 type (a, b) according to the size of coronal fragment of hamate fracture-type I: fracture-dislocation of 5th CMC joint with small-sized fragment or avulsion fracture of hamate, type IIa: fracture-dislocation of 4th and 5th CMC joint with small-sized fragment or avulsion fracture of hamate, type IIb: fracture-dislocation of 4th and 5th CMC joint with coronal fracture of hamate body presenting an oblique or coronal splitting fracture, and type III: type II injury associated with injury of 3rd CMC joint or coronal plane fracture of capitate. All cases were carried out the operative treatment. And radiologic results and clinical results were evaluated.
Results
Type I were 2 cases, type IIa 4, type IIb 5, and type III 3. Twelve of 14 cases were excellent or good results, 1 case (type III) was fair, and 1 case (type IIa) was poor. All cases obtained anatomic reduction of CMC joint. But, the posttraumatic arthritis was observed in 1 case (poor) and the displacement of non-fixed hamate fragment was observed in 1 case (fair).
Figures and Tables
Fig. 1
Type I injury.
(A) Preoperative radiographs show base fracture of 5th metacarpals, avulsion fracture of hamate and dislocation of 5th carpometacarpal joint.
(B) Anatomic reduction was achieved by closed reduction and percutaneous fixation with K-wires.
Fig. 2
(A) Type IIa injury with dorsal subluxation of 4th & 5th carpometacarpal joints and avulsion fracture of hamate.
(B) Open reduction and internal fixation with K-wires was treated.
Fig. 3
(A) Type IIb injury with subluxation of 4th & 5th carpometacarpal joints and coronal splitting fracture of hamate body.
(B) Fragment of hamate fracture was fixed with Acutrak screw.
Fig. 4
Type III injury. Preoperative radiograph (A) and CT (B) show coronal plane fracture of hamate & capitate, dorsal subluxation of 3rd/4th/5th carpometacarpal joints, and base fracture of 3rd & 4th metacarpals.
(C) Good result was achieved by open reduction and internal fixation with K-wires and mini-screws.
Fig. 5
Functional results by modified Mayo Score. One of type IIa cases was poor result that associated with fracture of 4th metacarpal neck and severe comminuted fracture of 5th metacarpal base. And one of type III cases was fair result because decreased motion of wrist and pain were caused by displacement of hamate fragment.
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