Open Reduction and Internal Fixation of Combined Fourth and Fifth Carpometacarpal (Fracture) Dislocations

Abstract

Traditionally, combined fourth and fifth carpometacarpal fracture dislocations are treated conservatively or by means of Kirschner wire after closed reduction. Since 1983, unstable dislocations have been treated with open reduction and screw fixation or with a temporary plate that bridges the fourth carpometacarpal (CMC) joint to maintain anatomical reduction. In a retrospective study, we evaluated the results of this surgical approach in a group of 11 patients and another group of 4 conservatively treated patients. Eleven patients were treated by means of open reduction and rigid screw fixation (n = 6) or plate bridging of the fourth CMC joint (n = 5). Reduction and fixation of the fourth CMC joint always led to spontaneous anatomical reduction of the fifth CMC joint. At long-term follow-up, nine of these patients had full recovery of their hand function without any complaints. Open reduction and internal fixation of unstable ulnar CMC dislocations produced excellent results.