William Beaumont Army Medical Center, El Paso, TX, USA.
Texas Tech University Health Sciences Center, El Paso, USA.
Hand (N Y). 2022 May;17(3):405-411. doi: 10.1177/1558944720948241. Epub 2020 Aug 8.
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.
A literature search was performed of all articles published on the surgical treatment and outcomes of ulnar CMC fracture dislocations using PubMed and Google Scholar databases between the years 2014 and 2019. Data were pooled and analyzed, assessing surgical techniques and hand outcome measures: union, recurrent dislocations, range of motion, grip strength, and complications.
Six studies met inclusion criteria. All surgical patients, regardless of technique, went on to union with no incidents of recurrent instability. Grip strength was significantly decreased postoperatively (82.7% of uninjured side). Patients with CMC dislocations of both the fourth and fifth ray had similar postoperative outcomes to those with CMC dislocations of the fifth ray alone. One third of plate and screw constructs required plate removal, due to breakage (2) or implant-related pain (4). Plate-related symptoms resolved after removal in all cases. Delayed treatment decreased the effectiveness of nonoperative treatment, and increased the likelihood of postoperative pain, chronic deformity, malunion, and CMC osteoarthritis.
Closed reduction percutaneous pinning, open reduction percutaneous pinning, and open reduction internal fixation with CMC joint bridging or dorsal buttress plating are all well described, safe techniques with low complication rates. Early, accurate diagnosis of fourth and fifth CMC joint fracture-dislocations is crucial for optimizing hand function and postoperative outcomes.
尺侧掌骨基底骨折可使腕掌（CMC）关节失去稳定性，从而需要手术稳定。研究此类损伤的文献有限，且病例量较少。我们旨在回顾 CMC 关节稳定术治疗尺侧掌骨基底骨折的手术技术、结果和并发症。
我们在 PubMed 和 Google Scholar 数据库中对 2014 年至 2019 年间发表的关于手术治疗和尺侧 CMC 骨折脱位结果的所有文章进行了文献检索。对数据进行汇总和分析，评估手术技术和手部结果测量指标：愈合、复发性脱位、活动范围、握力和并发症。
符合纳入标准的研究有 6 项。所有手术患者，无论采用何种技术，均愈合，且无再发性不稳定事件。术后握力明显下降（未受伤侧的 82.7%）。第四和第五掌骨 CMC 脱位患者的术后结果与第五掌骨 CMC 脱位患者相似。三分之一的板和螺钉结构因断裂（2 例）或植入物相关疼痛（4 例）需要取出钢板。所有病例在取出后，与钢板相关的症状均得到缓解。延迟治疗降低了非手术治疗的效果，并增加了术后疼痛、慢性畸形、愈合不良和 CMC 骨关节炎的可能性。
闭合复位经皮克氏针固定、切开复位经皮克氏针固定和切开复位内固定伴 CMC 关节桥接或背侧支撑钢板固定均为描述详细、安全的技术，并发症发生率低。早期准确诊断第四和第五 CMC 关节骨折脱位对于优化手部功能和术后结果至关重要。
