La luxation trapézo-métacarpienne fermée, récente, traitée par embrochage: A propos de sept cas avec un recul moyen de 8 ans

Abstract

Seven cases of acute and closed traumatic dislocation of the trapezio-metacarpal joint treated by percutaneous pinning adapted by Wiggins are reported with an average follow-up of eight years. Seven patients (five men and two women) aged 18 to 62 were treated. The injury was due to a road traffic accident in four cases. The dominant hand was injured in six cases. The metacarpal base was always dislocated dorsally and closed reduction always remained unstable. All cases consisted of closed dislocation but in two cases dislocation was associated with upper limb fractures. On the initial radiographs no patients had degenerative changes. All patients were treated as an emergency or the following during the days injury by reduction and stabilization by one or two percutaneous kirschner wires followed by a scaphoid cast for three to six weeks. All patients were followed and reviewed for this study between two and thirteen years (mean eight years) after injury. Enquiries were made about return to work, pain, stability, range of movement, key-pinch and grasp compared with the uninjured side. The joint was examined radiographically with particular attention to the presence of subluxation and degenerative changes. 2 patients with associated complex injury of the upper limb developed reflex sympathetic dystrophy. 2 patients had moderate pain, 2 patients had limitation of joint movement, 1 patient presented a reduction of strength (pinch and grasp) but none had subluxation, instability, or degenerative changes. Closed reduction and stabilization by percutaneous pinning is a simple method and gives good or excellent results in the treatment of acute traumatic dislocation of the trapezio-metacarpal joint.