Carpometacarpal Fracture-dislocations
Carpometacarpal Fracture-dislocations
Fracture-dislocation of the carpometacarpal (CMC) joints of the ring and little finger are
 the most affected CMC joints and the dislocation may be accompanied by other hand injuries.
 Fracture-dislocation of the CMC joints of the ring and little finger are extremely mobile
 because of their saddle shape anatomy and loose ligamentous attachments. Missed and incorrect
 diagnosis is very frequent in metacarpal base injuries of the hand and results in impaired
 function and weak grip. In these lesions immediate reduction is imperative. Treatment options
 for these injuries include non-operative management, closed reduction with Kirschner wire
 fixation (K-wire) and open reduction with internal fixation (ORIF). In chronic CMC
 fracture-dislocations ORIF is mandatory. Although operative treatment is recommended in the
 literature in fracture-dislocation of the CMC joints of the ring and little finger, other
 authors, in specific cases, performed conservative treatment through immediate reduction and
 splint immobilization and this treatment can be sufficient.
Physical examination in carpometacarpal injuries reveals ulnar-sided pain, swelling, diffuse
 edema, a palpable lump and tenderness of the hand.

 Radiological examination include hand-wrist radiographs in the posteroanterior (PA), true
 lateral and 45º oblique views. A true lateral view of the hand may demonstrate the
 dislocation, although overlapping of the joints can mask the dislocation. On PA radiographs,
 Fisher et al. propose using the so-called M-line parallelism of the CMC joints. A break in
 this M-line suggests a dislocation. Another method is to draw metacarpal cascade lines on a
 PA radiographs.

 It is important to recognise the associate lesions, for example hamate fractures, because
 this fracture can change the prognosis, surgical planning and treatment. The investigators
 hypothesized that there is an interobserver variability to evaluate the carpometacarpal
 fracture-dislocation and associated lesions in x-rays are underestimated. The investigators
 propose a protocol with a CT scan to asses this lesions. The researchers hypothesised that
 surgical reconstruction would result in better clinical result and lower complications rate
 than non-surgical treatment.
Inclusion Criteria:

 -  Closed carpometacarpal fracture dislocation of the hand

 -  Adults from 18 to 80 years old

 Exclusion Criteria:

 -  history of fractures or tendon lesions in the same hand

 -  Children

 -  Open fracture dislocations