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Orthop Surg 2021 Jun 10. 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 Apr 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) 2020 Aug 10:1558944720946485. 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) 2020 Aug 8:1558944720948241. 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

J Wrist Surg 2020 Apr 9;9(2):160-163. Epub 2019 May 9.

Department of Orthopaedic Surgery and Traumatology, Hospital Universitario Insular de Gran Canaria, Las Palmas de Gran Canaria, Spain.

 Ulnar carpometacarpal (CMC) joint dislocations and fracture-dislocations are uncommon injuries that are often overlooked. Most authors advocate surgical stabilization in order to prevent a secondary dislocation assuming that these injuries are inherently unstable.  This is a series of eight ulnar CMC joint dislocations and fracture-dislocations treated by closed reduction and splint immobilization after assessing the joint stability. Read More

Case Rep Orthop 2020 3;2020:6301692. Epub 2020 Mar 3.

Orthopaedic Trauma Center, Sapporo Tokushukai Hospital, Sapporo, Hokkaido, Japan.

We report a case of volar fourth and fifth carpometacarpal (CMC) joint dislocation complicated by a hamate hook fracture. The CMC joint was reduced in a closed fashion and temporally fixed with Kirschner wires. Using intraoperative computed tomography, the displaced fracture of the hamate hook was reduced by open reduction and internal fixation and fixed with a screw. Read More

J Orthop 2020 May-Jun;19:208-211. Epub 2019 Nov 6.

Department of Traumatology, Orthopaedics and Outpatient Surgery, Samara State Medical University, Samara, Russian Federation.

Currently, the most commonly used method of treatment of patients with fractures of the metacarpal bones is closed reposition with immobilization of short-arm cast. This often leads to dislocation of fragments, their malunion, which leads to wrist functionality disorders and reduces the quality of patients' life. The main way to eliminate the deformities ‒ osteotomy of the metacarpal bones, followed by osteosynthesis. Read More

Injury 2020 Mar 27;51(3):651-655. Epub 2020 Jan 27.

University of Health Sciences, Antalya Education and Research Hospital, Department of Emergency Medicine, Antalya, Turkey.

Background: This study aimed to compare CT and XR images of patients admitted to the emergency department due to wrist injuries and to evaluate the accuracy of XR in the diagnosis of fractures.

Methods: Patients; who admitted to ED with injuries due to wrist trauma and who underwent XR imaging and CT scans in the period from 1 January 2017 to 1 January 2018, were included in the study. CT scan image interpretation reports recorded in the hospital automation system were considered eligible to be included in the study. Read More

J Hand Surg Asian Pac Vol 2020 Mar;25(1):67-75

Department of Orthopedic Surgery, Medical Center of Chung-Ang University School of Medicine, Seoul, Korea.

This study aimed to describe a novel surgical technique in which a bridge plate was used for the treatment of hamatometacarpal fracture-dislocations and to assess its radiologic and clinical outcomes. A retrospective review of 16 patients treated with the bridge plate technique for hamatometacarpal fracture-dislocations was performed between 2010 and 2015. Clinical and radiographic evaluations were performed at months 3, 6, and 12 postoperatively. Read More

Int J Surg Case Rep 2019 9;65:267-270. Epub 2019 Nov 9.

Department of Plastic Surgery, Dankook University Hospital, Cheonan, Chungnam, South Korea.

Introduction: Iatrogenic fractures after failed K-wire fixation in the management of a carpometacarpal (CMC) joint fracture-dislocation have not yet been reported (Hsu et al., 2011). We present a case of K-wire-related complication in the management of a CMC joint fracture-dislocation and highlight the importance of planning K-wire placement and minimizing the number of K-wire passes. Read More

Bone Joint J 2019 10;101-B(10):1263-1271

Department of Research, Business Division Medicine, BG Kliniken - Klinikverbund der gesetzlichen Unfallversicherung gGmbH, Berlin, Germany.

Aims: The aim of this study was to investigate whether clinical and radiological outcomes after intramedullary nailing of displaced fractures of the fifth metacarpal neck using a single thick Kirschner wire (K-wire) are noninferior to those of technically more demanding fixation with two thinner dual wires.

Patients And Methods: This was a multicentre, parallel group, randomized controlled noninferiority trial conducted at 12 tertiary trauma centres in Germany. A total of 290 patients with acute displaced fractures of the fifth metacarpal neck were randomized to either intramedullary single-wire (n = 146) or dual-wire fixation (n = 144). Read More

Hand (N Y) 2019 Sep 13:1558944719873148. Epub 2019 Sep 13.

Keck Medical Center of University of Southern California, Los Angeles, USA.

Radiocarpal dislocations represent a high-energy wrist injury that can occur with or without concomitant fractures about the wrist. Poor outcomes are often due to radiocarpal instability and secondary ulnar translation. The purpose of this cadaveric study is to determine if there is any difference in the radiographic parameters in a wrist dislocation model given the different location of distal fixation. Read More

Injury 2019 Aug 28;50(8):1470-1477. Epub 2019 Jun 28.

Trauma Research Unit Department of Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.

Purpose: Open reduction and internal fixation (ORIF) of Bennett fractures is increasingly preferred over closed reduction and percutaneous fixation (CRIF) in an attempt to prevent the development of post-traumatic arthrosis. The aim of this systematic review was to determine whether the preference for ORIF is justified based on the available literature regarding functional outcome and complications after surgery.

Methods: A systematic review was performed in Medline, Embase, Cochrane CENTRAL, Web of science, and Google scholar. Read More

Hand (N Y) 2021 May 11;16(3):362-367. Epub 2019 Jun 11.

The University of Oklahoma, Oklahoma City, USA.

The purpose of this study was to evaluate the demographics and early radiographic treatment outcome of patients with carpometacarpal (CMC) injuries at our institution over a 10-year period. We conducted a retrospective review of all patients who sustained CMC injuries of the second to fifth digits between 2005 and 2015. We recorded demographic data, mechanisms of and associated injuries, treatment methods, and complications. Read More