J Korean Fract Soc.  2011 Jan;24(1):60-66. 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

Affiliations
  • 1Department of Orthopedic Surgery, Wonju College of Medicine, Yonsei University, Wonju, Korea. jroh@yonsei.ac.kr

Abstract

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

Keyword

4th, 5th metacarpal base; Early fixation; Delayed fusion

MeSH Terms

Carpometacarpal Joints
Early Diagnosis
Follow-Up Studies
Hand Strength
Intra-Articular Fractures
Metacarpophalangeal Joint
Range of Motion, Articular
Retrospective Studies

Figure

  • 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 4th, 5th carpometacarpal joint by traffic accident (A). For firm fixation of hamate, 4th 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).


Cited by  1 articles

Fourth and Fifth Metacarpal Base Arthrodesis for Posttraumatic Arthritis of Fifth Carpometacarpal Joint
Chul-Hyung Kang, Eun-Sok Son, Chul-Hyun Cho
J Korean Soc Surg Hand. 2013;18(4):184-188.    doi: 10.12790/jkssh.2013.18.4.184.


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