Mini locked-plate trans-carpometacarpal joint internal fixation for treating comminuted fracture of base of the fifth metacarpal_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

XIE Zheng , ZHANG Jiaqiang , YIN Gang , CHEN Huihao , HU Haoliang ,  LIN Haodong , HOU Chunlin

Department of Bone Trauma and Reconstructive Surgery, Changzheng Hospital Affiliated to Naval Medical University【核单位英文名称？】, Shanghai, 200003, P.R.China;

Corresponding author：

LIN Haodong, Email: haodonglin@hotmail.com

Keywords：

Mini locked-plate; comminuted fracture; base of the fifth metacarpal; trans-carpometacarpal joint approach; internal fixation

DOI：

10.7507/1002-1892.201805077

Video：

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Objective To evaluate the effectiveness of open reduction and trans-carpometacarpal joint internal fixation with mini locked-plate for treatment of comminuted fracture of base of the fifth metacarpal. Methods Between July 2015 and December 2017, 8 cases of comminuted fractures of base of the fifth metacarpals were treated with open reduction and trans-carpometacarpal joint internal fixation with mini locked-plate. There were 7 males and 1 female with an age of 19-45 years (mean, 32.5 years). The causes of injury included 2 cases of hitting hard objects while clenching fist, 6 cases of falling injury. There were 2 cases of subluxation of fifth carpal joints and 1 case of dislocation. The time from injury to operation was 1-5 days (mean, 3.5 days). The stability of fracture ends could not be maintained by preoperative evaluation without over articular fixation or short time over articular fixation. Postoperative complications and fracture healing were observed, and hand function was evaluated at last follow-up according to the total active motion (TAM) recommended by the Branch of Hand Surgery of Chinese Medicine Association. Results All the incisions healed by first intention without complications such as wound infection, cutaneous necrosis, tendon or nerve injury. All the patients were followed up 6-18 months (mean, 12 months). All fractures healed with the healing time of 12-16 weeks (mean, 13 weeks). Within 4 months after operation, all patients were able to return to pre-injury job. At last follow-up, according to the TAM recommended by the Branch of Hand Surgery of Chinese Medicine Association, the results were excellent in 7 cases, good in 1 case, with the excellent and good rate of 100%. Conclusion Applying of mini locked-plate for treatment of comminuted fractures of base of the fifth metacarpal, of which cannot obtain stable fixation through non-transarticular or short-time transarticular fixation, can achieve satisfactory functional results with very few complications through trans-carpometacarpal joint approach, thus the procedure can be used as an alternative operation scheme.

Citation： XIE Zheng, ZHANG Jiaqiang, YIN Gang, CHEN Huihao, HU Haoliang, LIN Haodong, HOU Chunlin. Mini locked-plate trans-carpometacarpal joint internal fixation for treating comminuted fracture of base of the fifth metacarpal. Chinese Journal of Reparative and Reconstructive Surgery, 2018, 32(11): 1382-1385. doi: 10.7507/1002-1892.201805077 Copy

1.	Henderson JJ, Arafa MA. Carpometacarpal dislocation.An easily missed diagnosis. J Bone Joint Surg (Br), 1987, 69(2): 212-214.
2.	Clement BL. Fracture-dislocation of the base of the fifth metacarpal. A case report. J Bone Joint Surg, 1945, 27A: 498-499.
3.	Caldwell RA, Shorten PL, Morrell NT. Common upper extremity fracture eponyms: a look into what they really mean. J Hand Surg (Am), 2018.[Epub ahead of print].
4.	Goedkoop AY, van Onselen EB, Karim RB, et al. The ’mirrored’ Bennett fracture of the base of the fifth metacarpal. Arch Orthop Trauma Surg, 2000, 120(10): 592-593.
5.	Biswas S, Lee R, Patel A, et al. " Mirrored” rolando’s fracture of the base of the fifth metacarpal. Eplasty, 2014, 14: ic41.
6.	Lundeen JM, Shin AY. Clinical results of intraarticular fractures of the base of the fifth metacarpal treated by closed reduction and cast immobilization. J Hand Surg (Br), 2000, 25(3): 258-261.
7.	Miyamoto H, Adi M, Taleb C, et al. Fifth carpometacarpal fracture dislocations fixed with Meta-HUS®: a series of 31 cases. Eur J Orthop Surg Traumatol, 2015, 25(3): 477-482.
8.	吴中桓, 孙广峰, 金文虎, 等. 第五掌骨基底部骨折治疗进展. 中华临床医师杂志 (电子版), 2015, 9(10): 177-181.
9.	潘达德, 顾玉东, 侍德, 等. 中华医学会手外科学会上肢部分功能评定试用标准. 中华手外科杂志, 2000, 16(3): 130-135.
10.	Dubert TP, Khalifa H. " Stabilized arthroplasty” for old fracture dislocations of the fifth carpometacarpal joint. Tech Hand Up Extrem Surg, 2009, 13(3): 134-136.
11.	Niechajev I. Dislocated intra-articular fracture of the base of the fifth metacarpal: a clinical study of 23 patients. Plast Reconstr Surg, 1985, 75(3): 406-410.
12.	Cannon SR, Dowd GS, Williams DH, et al. A long-term study following Bennett’s fracture. J Hand Surg (Br), 1986, 11(3): 426-431.
13.	Cobb WA, Dingle L, Zarb Adami R, et al. Management of fracture-dislocations of the little finger carpometacarpal joint: a systematic review. J Hand Surg Eur Vol, 2018, 43(5): 530-538.
14.	Bushnell BD, Draeger RW, Crosby CG, et al. Management of intra-articular metacarpal base fractures of the second through fifth metacarpals. J Hand Surg (Am), 2008, 33(4): 573-583.
15.	Büren C, Gehrmann S, Kaufmann R, et al. Management algorithm for index through small finger carpometacarpal fracture dislocations. Eur J Trauma Emerg Surg, 2016, 42(1): 37-42.
16.	Bora FW Jr, Didizian NH. The treatment of injuries to the carpometacarpal joint of the little finger. J Bone Joint Surg (Am), 1974, 56(7): 1459-1463.
17.	刘坤, 田文, 杨勇, 等. 闭合或有限切开复位微型外固定架联合克氏针固定治疗闭合性第 5 掌骨底骨折或脱位. 骨科临床与研究杂志, 2017, 9(2): 273-278.
18.	Tan ES, Chao TS. Dorsal buttress plate fixation of ulnar carpometacarpal joint fracture dislocations. Tech Hand Up Extrem Surg, 2016, 20(2): 77-82.

1. Henderson JJ, Arafa MA. Carpometacarpal dislocation.An easily missed diagnosis. J Bone Joint Surg (Br), 1987, 69(2): 212-214.
2. Clement BL. Fracture-dislocation of the base of the fifth metacarpal. A case report. J Bone Joint Surg, 1945, 27A: 498-499.
3. Caldwell RA, Shorten PL, Morrell NT. Common upper extremity fracture eponyms: a look into what they really mean. J Hand Surg (Am), 2018.[Epub ahead of print].
4. Goedkoop AY, van Onselen EB, Karim RB, et al. The ’mirrored’ Bennett fracture of the base of the fifth metacarpal. Arch Orthop Trauma Surg, 2000, 120(10): 592-593.
5. Biswas S, Lee R, Patel A, et al. " Mirrored” rolando’s fracture of the base of the fifth metacarpal. Eplasty, 2014, 14: ic41.
6. Lundeen JM, Shin AY. Clinical results of intraarticular fractures of the base of the fifth metacarpal treated by closed reduction and cast immobilization. J Hand Surg (Br), 2000, 25(3): 258-261.
7. Miyamoto H, Adi M, Taleb C, et al. Fifth carpometacarpal fracture dislocations fixed with Meta-HUS®: a series of 31 cases. Eur J Orthop Surg Traumatol, 2015, 25(3): 477-482.
8. 吴中桓, 孙广峰, 金文虎, 等. 第五掌骨基底部骨折治疗进展. 中华临床医师杂志 (电子版), 2015, 9(10): 177-181.
9. 潘达德, 顾玉东, 侍德, 等. 中华医学会手外科学会上肢部分功能评定试用标准. 中华手外科杂志, 2000, 16(3): 130-135.
10. Dubert TP, Khalifa H. " Stabilized arthroplasty” for old fracture dislocations of the fifth carpometacarpal joint. Tech Hand Up Extrem Surg, 2009, 13(3): 134-136.
11. Niechajev I. Dislocated intra-articular fracture of the base of the fifth metacarpal: a clinical study of 23 patients. Plast Reconstr Surg, 1985, 75(3): 406-410.
12. Cannon SR, Dowd GS, Williams DH, et al. A long-term study following Bennett’s fracture. J Hand Surg (Br), 1986, 11(3): 426-431.
13. Cobb WA, Dingle L, Zarb Adami R, et al. Management of fracture-dislocations of the little finger carpometacarpal joint: a systematic review. J Hand Surg Eur Vol, 2018, 43(5): 530-538.
14. Bushnell BD, Draeger RW, Crosby CG, et al. Management of intra-articular metacarpal base fractures of the second through fifth metacarpals. J Hand Surg (Am), 2008, 33(4): 573-583.
15. Büren C, Gehrmann S, Kaufmann R, et al. Management algorithm for index through small finger carpometacarpal fracture dislocations. Eur J Trauma Emerg Surg, 2016, 42(1): 37-42.
16. Bora FW Jr, Didizian NH. The treatment of injuries to the carpometacarpal joint of the little finger. J Bone Joint Surg (Am), 1974, 56(7): 1459-1463.
17. 刘坤, 田文, 杨勇, 等. 闭合或有限切开复位微型外固定架联合克氏针固定治疗闭合性第 5 掌骨底骨折或脱位. 骨科临床与研究杂志, 2017, 9(2): 273-278.
18. Tan ES, Chao TS. Dorsal buttress plate fixation of ulnar carpometacarpal joint fracture dislocations. Tech Hand Up Extrem Surg, 2016, 20(2): 77-82.

Chinese Journal of Reparative and Reconstructive Surgery

Mini locked-plate trans-carpometacarpal joint internal fixation for treating comminuted fracture of base of the fifth metacarpal

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