Comparison of Early Fixation and Late Fusion of 4, 5th Carpometacarpal Joint in the Intra-Articular Fractures of 4th and 5th Metacarpal Base

Chang Ho Yi; Jin Rok Oh

doi:10.12671/jkfs.2011.24.1.60

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Yi and Oh: Comparison of Early Fixation and Late Fusion of 4, 5th Carpometacarpal Joint in the Intra-Articular Fractures of 4th and 5th Metacarpal Base

Original Article

Journal of the Korean Fracture Society

Journal of the Korean Fracture Society 2011; 24(1): 60-66.

Published online: 21 January 2011

DOI: https://doi.org/10.12671/jkfs.2011.24.1.60

Comparison of Early Fixation and Late Fusion of 4, 5th Carpometacarpal Joint in the Intra-Articular Fractures of 4th and 5th Metacarpal Base

Chang Ho Yi, M.D., Jin Rok Oh, M.D.

Department of Orthopedic Surgery, Wonju College of Medicine, Yonsei University, Wonju, Korea.

Address reprint requests to: Jin Rok Oh, M.D. Department of Orthopedic Surgery, Yonsei University Wonju College of Medicine, 162, Ilsan-dong, Wonju 220-701, Korea. Tel: 82-33-741-1355·Fax: 82-33-746-7326, jroh@yonsei.ac.kr

Received 24 July 2010 Revised 17 December 2010 Accepted 29 December 2010

(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

To evaluate clinical results between early fixation group and delayed fusion group in treatment of intraarticular fracture of 4^th, 5^th metacarpal base.

Materials and Methods

From March 2002 to December 2006, 21 cases of early fusion and 11 cases of delayed fusion of 4, 5th carpometacarpal joint were reviewed retrospectively or were included in this study. Average follow up period is 39.9 months. Bony union was checked by plain films at follow up. DASH-questionnaire, VAS pain scale, grip power and range of motion of 4^th, 5^th metacarpophalangeal joint were also checked at last follow up.

Results

In radiologic study, bony union was confirmed in all cases of two groups. Early fixation group showed better outcomes than delayed fusion group in range of motion, DASH-questionnaire and VAS pain scale with statistical significant (p<0.004).

Conclusion

Because early fixation group showed better clinical outcomes than delayed fusion group, early diagnosis and proper surgical treatment are important for better outcomes in treatment of intraarticular fracture of 4^th, 5^th metacarpal base.

Keywords: 4^th, 5^th metacarpal base, Early fixation, Delayed fusion

Figures and Tables

Fig. 1

Three-dimensional reconstruction image of computed tomography shows the intraarticular fractures occurred simultaneously in the fourth and fifth metacarpal base.

Fig. 2

24 year-old patient came with fractures in the fourth and fifth metacarpal base by traffic accident (A).

He diagnosed immediately at emergency department, so he was taken surgery at two day after trauma (B).

At postoperative 9 months, bony union was confirmed in plain film (C).

Fig. 3

18 year-old patient came with fractures in the fourth metacarpal base and hamate with dislocation of 4^th, 5^th carpometacarpal joint by traffic accident (A).

For firm fixation of hamate, 4^th metacarpal bone and hamate were tied up together by hand mini plate & screws (B).

At postoperative 12 months, bony union was confirmed in plain film (C).

Fig. 4

54 year-old female came to outpatient department complained prolonged pain at the fourth and fifth metacarpal base area after fall down injury 2 months ago (A).

Because of non-union, she was taken arthrodesis with autoiliac bone graft with hand-mini plate and screws (B).

At postoperative 11 months, fused fourth and fifth carpometacarpal joint was confirmed in plain film (C).

Table 1

Comparison of results between immediate fixation group and delayed reconstruction group of intra-articular metacarpal base fractures of the fourth through fifth metacarpals

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