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Hand (N Y) 2022 Jun 6:15589447221096705. Epub 2022 Jun 6.

Division of Plastic Surgery, University of British Columbia, Vancouver, Canada.

Traumatic thumb injuries often result in significant functional disability. With segmental bone loss, reconstructive options include antibiotic cement with delayed bone graft, revision amputation with webspace deepening, metacarpal distraction osteogenesis, index pollicization, bone flap, and free toe transfer. We present a case of a subtotal thumb amputation just distal to the metacarpal phalangeal joint resulting in loss of both soft tissue and a segmental bone defect of the proximal and distal phalanx. Read More

J Orthop Case Rep 2021 Sep;11(9):24-28

Department of Trauma and Orthopaedics, Arrowe Park Hospital, Arrowe Park Road, Wirral - CH49 5PE, UK.

Introduction: Carpo-metacarpal joint fracture-dislocations are rare injuries. They constitute less than 1% of all hand injuries [1]. They often go unnoticed [2]. Read More

Arch Acad Emerg Med 2022 9;10(1):e13. Epub 2022 Feb 9.

Bone and Joint Reconstruction Research Center, Department of Orthopedics, School of Medicine, Iran University of Medical Sciences, Tehran, Iran.

Complex metacarpophalangeal (MCP) joint dislocation is an uncommon entity, which occurs following a hyperextension injury. Closed reduction is not feasible due to entrapped volar plate and/or coexisting fractures. Various approaches and techniques have been proposed for treatment of complex MCP dislocation; however, controversies exist over which one is superior. Read More

Hand Surg Rehabil 2022 Jun 12;41(3):281-295. Epub 2022 Feb 12.

Service de chirurgie orthopédique et traumatologique, chirurgie plastique, Centre Hospitalier Régional Universitaire de Besançon, 3 Boulevard Fleming, 25000 Besançon, France.

Traumatic lesions around the base of the thumb have special features due to the location and structure of the joint and its inherent potential instability. This causes different fracture patterns, which are mostly isolated around the metacarpal base but can also involve just the trapezium or both. Exceptionally, there may be isolated dislocation. Read More

Unfallchirurg 2022 Feb 18;125(2):97-106. Epub 2021 Dec 18.

Orthopädie Ackermann, Raiffeisenstr. 58-60, 47259, Duisburg, Deutschland.

In this article the basic principles of fracture sonography and meaningful areas of application in children and adults are explained. The sonographic fracture signs are presented and the typical areas of application, i.e. Read More

Clin Pract Cases Emerg Med 2021 Nov;5(4):488-490

AMITA Health Resurrection Medical Center, Department of Emergency Medicine, Chicago, Illinois.

Case Presentation: A 17-year-old male presented to the emergency department (ED) due to trauma to the right hand and wrist after punching a locker at school. He had significant soft tissue swelling. Radiographs demonstrated intra-articular metacarpal fractures with associated carpometacarpal dislocations. Read More

J Orthop Case Rep 2021 May;11(5):99-103

Department of Orthopaedics and Traumatology, Centro Hospitalar Tondela-Viseu, Viseu Dão Lafões, Portugal.

Introduction: Trapezium fracture is a rare entity whose treatment is controversial. The reported cases range from conservative treatment to surgical treatment with good reported results.

Case Report: This paper reports a clinical case of trapezium-metacarpal fracture-dislocation associated with trapezius fracture and Bennett fracture, surgically treated with excellent functional and radiological results. Read More

Semin Musculoskelet Radiol 2021 Apr 9;25(2):277-293. Epub 2021 Aug 9.

Department of Radiology, Antwerp University Hospital, Edegem, Belgium.

Acute bony injuries to the hand and wrist are very common after a fall on an outstretched hand. In the wrist, distal radius fractures are the most common; isolated distal ulna fractures are uncommon. More serious injuries to the wrist include complicated fracture-dislocation injuries such as perilunate dislocations. Read More

Case Reports Plast Surg Hand Surg 2021 26;8(1):110-113. Epub 2021 Jul 26.

Department of Plastic Surgery, Treant Health Care Group: Hospital Location Bethesda, Hoogeveen, The Netherlands.

We present an open and isolated palmar dislocation of the head of the fifth metacarpal bone without fracture. The diagnosis, which was initially made based on the X-rays, was confirmed during the operation. The patient was satisfactorily treated with open reduction, Kirschner wires fixation and casting followed with hand physiotherapy. Read More

J Plast Reconstr Aesthet Surg 2022 Jan 23;75(1):286-295. Epub 2021 Jun 23.

Department of Plastic Reconstructive and Aesthetic Surgery, Ankara Research and Training Hospital, Ankara, Turkey.

Background: Hand fractures constitute 20% of hand injury patients who apply to emergency services. Conservative approaches are satisfactory in the majority of the cases. However, the minority group in need of surgery reaches a serious number of patients considering the frequency of these injuries. Read More

Hand Surg Rehabil 2021 Dec 9;40(6):765-770. Epub 2021 Jul 9.

SOS Main Grenoble, Unité de Chirurgie Réparatrice, de la Main et des Brûlés, Hôpital Albert Michallon, CHU de Grenoble, avenue du Marquis-de-Grésivaudan, BP 217, 38043 Grenoble cedex 09, France.

The goal of this study was to describe the long-term functional outcomes of the procedure described by Dubert (stabilized arthroplasty with intermetacarpal arthrodesis) for painful carpometacarpal impingement of the little finger. Between 2005 and 2017, 8 patients (1 woman and 7 men) were operated on who had a mean age of 38 years (24-53 years). Seven cases were post-traumatic (malunion) and one was due to septic arthritis. Read More

Orthop Surg 2021 Jul 10;13(5):1596-1601. Epub 2021 Jun 10.

Department of Orthopaedic Surgery, Nanjing First Hospital, Nanjing Medical University, Nanjing, China.

Objective: Complex base fractures of the fifth metacarpal bone and dislocation of the fifth carpometacarpal joint are more prone to internal rotation deformity of the little finger sequence after fixation with a transarticular plate. In the past, we have neglected that there is actually a certain angle of external rotation in the hamate surface of transarticular fixation. This study measured the inclination angle of the hamate surface relative to the fifth metacarpal surface for clinical reference. Read More

J Hand Surg Asian Pac Vol 2021 Jun;26(2):240-244

Upper Extremity and Reconstructive Unit, Institute of Orthopaedics, Lerdsin Hospital, Department of Orthopaedic Surgery, College of Medicine, Rangsit University, Bangkok, Thailand.

Hemi-hamate arthroplasty is one of the treatment options for dorsal proximal interphalangeal joint fracture dislocation. Many studies reported favorable outcomes. However, some long term studies demonstrated the degenerative change of PIP joint. Read More

J Hand Microsurg 2021 Apr 9;13(2):89-94. Epub 2020 Apr 9.

Department of Trauma and Orthopaedic, Cardiff and Vale University Health Board, University Hospital of Wales, Cardiff, United Kingdom.

 Little and ring finger carpometacarpal joints (CMCJs) injuries are commonly missed due to misinterpretation of radiographs. We aimed to determine the sensitivity and specificity of four different radiographic views.  Radiographs (posteroanterior [PA], lateral [LAT], pronated oblique [POL], and supinated oblique [SOL] views) showing normal findings or little/ring finger CMCJ injuries were shown to two cohorts of orthopaedic trainees and a cohort of emergency nurse practitioners. Read More

Hand (N Y) 2021 Apr 9:15589447211003181. Epub 2021 Apr 9.

University of Minnesota, Minneapolis, USA.

Background: This study compared the incidence of loss of reduction (LOR) between metacarpal fractures fixed with screws alone and those fixed with plates and screws. Secondary aims included identifying patient or fracture characteristics associated with increased risk of LOR.

Methods: We retrospectively reviewed 138 metacarpal fractures in 106 patients treated with open reduction internal fixation with screws (60 fractures) or plates and screws (78 fractures) with a mean radiographic follow-up of 50 days for evidence of LOR. Read More

J Wrist Surg 2021 Apr 27;10(2):164-168. Epub 2020 Aug 27.

Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan.

 Fracture-dislocations of all four ulnar (second to fifth) carpometacarpal (CMC) joints are rare hand injuries and frequently overlooked or missed. These injuries can be treated conservatively when closed reduction is successfully achieved, though they are sometimes irreducible and unstable.  We report the case of a 17-year-old boy involved in a vehicular accident. Read More

Hand (N Y) 2021 Feb 3:1558944720988073. Epub 2021 Feb 3.

Rothman Institute, Philadelphia, PA, USA.

Common forms of fixation of metacarpal fractures have historically included percutaneous Kirschner wire fixation, plates and screws, and, more recently, intramedullary screw fixation. Retrograde intramedullary screws (RISs) are a novel modality first described 10 years ago. The purpose of this review is to critically evaluate the published literature assessing outcomes of RIS fixation for metacarpal fractures and create a complication profile for this novel technique. Read More

BMC Musculoskelet Disord 2021 Jan 4;22(1). Epub 2021 Jan 4.

Department of Hand Surgery, Beijing Ji Shui Tan Hospital and the 4th Medical College of Peking University, Xin jie kou dong jie 31, Xi Cheng Qu, Beijing, 100035, China.

Background: Restoration of joint congruity is an important factor for the prevention of subsequent arthritis in patients with Bennett's fracture. Surgical treatment of Bennett's fracture is thus generally recommended for displaced intra-articular fractures to the proximal aspect of the thumb metacarpal. Fluoroscopic examination is used to evaluate the adequacy of closed reduction after pinning of Bennett's fracture. Read More

Hand (N Y) 2020 Dec 21:1558944720974116. Epub 2020 Dec 21.

University of Pittsburgh, PA, USA.

Background: It is recommended to have 6 bicortical screws for plate fixation of long bone fractures; however, many metacarpal fractures do not allow 6 screws due to size limitations and proximity of crucial anatomical structures. The purpose of this biomechanical study was to determine whether the mechanical properties of a 4-screw nonlocking construct are noninferior to those of a 6-screw nonlocking construct.

Methods: Metacarpal sawbones were used to simulate a midshaft, transverse fracture. Read More

Hand Surg Rehabil 2021 04 5;40(2):198-201. Epub 2020 Dec 5.

Hand Surgery and Peripheral Nerves Unit, Division of Orthopedics and Trauma Surgery, Geneva University Hospital, Rue Gabrielle Perret Gentil 4, 1211 Geneva, Switzerland.

Trapeziometacarpal dislocation is a rare traumatic lesion, especially in the pediatric population. Various treatments have been described for acute cases. We report the case of a 15-year-old boy who was admitted in the emergency department with chronic post-traumatic trapeziometacarpal dislocation due to an untreated first metacarpal base fracture (Bennett), with complete articular destruction. Read More

Hand (N Y) 2020 Nov 30:1558944720974363. Epub 2020 Nov 30.

University of Nottingham, UK.

Metacarpal shaft fractures are common hand injuries that predominantly affect younger patients. There is wide variability in their treatment with no consensus on best practice. We performed a systematic review to assess the breadth and quality of available evidence supporting different treatment modalities for metacarpal shaft fractures of the finger digits in adults. Read More

BMC Musculoskelet Disord 2020 Oct 15;21(1):683. Epub 2020 Oct 15.

Department of Orthopaedic Surgery, University of Occupational and Environmental Health, 807-8555 Iseigaoka Yahatanisiku, Kitakyusyu City, Fukuoka, Japan.

Background: Scaphoid excision and four-corner arthrodesis is an acceptable salvage procedure for the treatment of scapholunate advanced collapse (SLAC) and scaphoid nonunion advanced collapse (SNAC) wrists, since first popularized in the 1980s. We investigated the potential application of novel bioabsorbable plates and screws made of un-sintered hydroxyapatite/poly-L-lactide composite for the treatment of metacarpal fractures. We used this material for the fixation of four-corner fusions for SLAC or SNAC wrists commencing from April 2009. Read More

Microsurgery 2021 Feb 4;41(2):170-174. Epub 2020 Oct 4.

Department of Orthopaedic Surgery, Gifu University Graduate School of Medicine, Gifu, Japan.

Osteochondral fractures of the fingers are challenging to treat, and it is mandatory to acquire early bone union and joint surface reconstruction to obtain satisfactory outcomes. These injuries sometimes occur as open fractures with poor soft tissue condition and bone defect adjacent to osteochondral fragment. For such cases, surgical treatment can be more difficult, and vascularized bone graft (VBG) could be a useful method for joint reconstruction. Read More

Oper Orthop Traumatol 2020 Oct 16;32(5):396-409. Epub 2020 Sep 16.

Klinik für Handchirurgie, Von Guttenbergstr. 11, 97616, Bad Neustadt an der Saale, Deutschland.

Objective: a) Fixed-angle bridging of the wrist between radius diaphysis and metacarpus by percutaneous or minimally invasively inserted threaded pins and a frame (fixator) placed above the skin level (external); b) retention of fracture fragments by ligamentotaxis; c) temporary stabilization after bone loss at wrist and distal forearm.

Indications: a) Initial treatment of fractures near the wrist or soft tissue injuries in multiple trauma patients; b) fractures of the distal radius and the distal ulna; c) dislocation of the carpus; d) infections of the wrist; e) instability after resection in the wrist area; f) fractures with impending or manifest compartment syndrome; g) fractures with extensive loss of soft tissues and lacking coverage of implants.

Contraindications: a) Pathological changes at the site of pin application, as long as no alternative site is possible: infections, fractures, osteoporosis, tumors; b) fractures that are closed and not reduceable; c) exclusively intra-articular distal radius fractures; d) lack of compliance by the patient. Read More

JBJS Case Connect 2020 Jul-Sep;10(3):e1900558

1Department of Orthopaedics, Maulana Azad Medical College & Lok Nayak Hospital, New Delhi, India.

Case: We present a rare combined convergent-divergent carpometacarpal (CMC) fracture dislocation with median nerve involvement in a young adult after a motorbike accident. Radiographs revealed a volar dislocation of the second and fifth metacarpals and dorsal dislocation of the third and fourth metacarpals with bases of the second and fifth metacarpals found to be converging in the coronal plane. Open reduction and fixation was performed with carpal tunnel release. Read More

Hand (N Y) 2022 05 10;17(3):412-415. Epub 2020 Aug 10.

University of Mississippi Medical Center, Jackson, MS, USA.

Background: Clinical series have been published using the configuration of 2 intercarpal Kirschner wires (K-wires) adjacent to the fracture being connected, but biomechanical analysis is lacking. The objective of this pilot biomechanical study was to model and compare the effects of externally connecting 2 intermetacarpal K-wires for the stabilization of transverse metacarpal shaft fractures. Our research hypothesis was that the connected constructs would be stiffer than the unconnected K-wires. Read More

Hand (N Y) 2022 05 8;17(3):405-411. Epub 2020 Aug 8.

William Beaumont Army Medical Center, El Paso, TX, USA.

Background: Ulnar metacarpal base fractures can destabilize the carpometacarpal (CMC) joint, prompting surgical stabilization. Studies investigating this injury are limited by small case volumes. Our purpose is to review the surgical techniques, outcomes, and complications of ulnar CMC joint stabilization. Read More

Ann Chir Plast Esthet 2021 Apr 3;66(2):180-183. Epub 2020 Aug 3.

Institut Universitaire Locomoteur et du Sport (IULS), Service de Chirurgie Réparatrice et de la Main, CHU de Nice, Hôpital Pasteur 2, Nice, France; Laboratoire d'Anatomie humaine, Faculté de Médecine de Nice, Université Côte d'Azur, Nice, France. Electronic address:

Posttraumatic acute carpal tunnel syndrome is a not a usual complication in traumatic hand injuries but requires more urgent and aggressive management. Compression of the median nerve should be systematically sought when there is a major and painful swelling of the hand, associated with one or several hand and wrist fractures. In rare case, a single metacarpal fracture or dislocation can be the only cause of median nerve compression and requires urgent diagnosis. Read More

JBJS Case Connect 2020 Apr-Jun;10(2):e0361

1Department of Orthopaedic Surgery, Kushiro Rosai hospital, Kushiro, Japan 2Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan.

Case: Coronal shear fractures of the hamate are relatively rare injuries. Surgical intervention is recommended for displaced fractures. However, there is no established surgical procedure for the displaced coronal shear fractures of the hamate. Read More