Metacarpal fracture surgery with screws2/18/2024 These new classification systems have focused on more specific features, such as the presence of metacarpal base fractures and the size of the intra-articular hamate fracture fragment. The original classification system of CMC ⅘ fracture-dislocations was developed by Cain et al and was based on the orientation of the hamate fracture line.Īdvances in diagnostic imaging have allowed for more accurate assessment of injury morphology to the hamatometacarpal complex, which has resulted in the development of novel classification systems. Computed tomography (CT) can be more useful for the diagnosis and for an accurate definition of the fracture pattern. Plain radiography is not optimal to evaluate this area of the carpal anatomy, due to the irregular topography, small fracture fragments, and complex articulations. Hamate fractures represent only 2 to 4% of all carpal fractures, with injuries to the hamate body being the most rare variant.Ĭoexistence with carpometacarpal (CMC) dislocation accounts for less than 1% of all hand trauma.Ī high clinical suspicion and adequate use of radiological tests are required for diagnosing the injury.Īn early diagnosis is essential to avoid or minimize the risk for fracture malunion, nonunion, posttraumatic arthritis, and chronic pain. Fracture morphology does not appear to guide choice for specific hardware (size screw, headed/headless) or use of a washer. Our study has shown favorable outcomes after open reduction and internal fixation of the hamate body fracture with interfragmentary screws, when combined with stabilization of the CMC dislocation with percutaneous Kirschner wires. Radiographic review showed restoration of anatomy and well-maintained congruity of the CMC joints. There were no complications or reoperations during the postoperative period. At a mean of 96 days follow-up (range: 31–265), all patients had recovered wrist motion, excellent grip strength, and complete resolution of pain. An open, dorsal approach to the hamate was used with a combination of interfragmentary screw fixation and Kirschner wire reduction in the CMC joints. ![]() We conducted a retrospective review of six patients with carpometacarpal (CMC) ⅘ fracture-dislocations managed with ORIF by a single surgeon between October 2006 and August 2017.
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