DIAGNOSE AND TREATMENT OF INTRA-ARTICULAR FRACTURE OF FIFTH METACARPALE BASE WITH CARPOMETACARPAL JOINT DISLOCATION_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

ZHAO Min ¹ , TIAN Dehu ² , SHAO Xinzhong ² , LI Dacun ¹ , LI Jianfeng ¹ , LIU Jingda ¹ , ZHAO Liang ¹ , LI Hailei ¹ , WANG Xiaolei ¹ , ZHANG Wentong ¹

1Department of Upper Limb Surgery, Beijing Shunyi Hospital, Beijing, 101300, P.R.China;;
2Department of Hand Surgery, the Third Affiliated Hospital of Hebei Medical University. Corresponding author: ZHAO Min, E-mail: zhaomin699@163.com;

Corresponding author：

Keywords：

Reverse; Bennett fracture Intra-articular fracture of the; 5th metacarpale base; Carpometacarpal joint dislocation; Internal fixation

DOI：

10.7507/1002-1892.20130147

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Objective To investigate the diagnose and treatment of intra-articular fracture of the 5th metacarpale base with carpometacarpal joint dislocation (reverse Bennett fracture). Methods Between January 2008 and March 2012, 26 cases of reverse Bennett fracture were treated. There were 20 males and 6 females, aged 19-48 years (mean, 26 years). The injury causes included boxing injury in 19 cases, falling injury in 3 cases, heavy pound injury in 3 cases, and crushing injury in 1 case. According to Lundeen classification, there were 8 cases of type A, 9 cases of type B, 3 cases of type C, and 6 cases of type D. The time from injury to operation ranged 1-8 days with an average of 4 days. All patients underwent open reduction and internal fixation with Kirschner wires, screws, or plates by L-shaped dorsal incision. Results Primary healing was obtained in all incisions; no infection, hematoma, and necrosis occurred after operation. All patients were followed up with an average time of 12.5 months (range, 8-24 months). X-ray films showed that all fractures healed after 6-8 weeks (mean, 6.5 weeks); no delayed union or nonunion and no the 5th carpometacarpal joint dislocation were observed. Two cases had mild osteoarthritis. According to the upper extremity functional evaluation standard by Hand Surgery Branch of Chinese Medical Association, the results were excellent in 22 cases, good in 3 cases, and fair in 1 case, with an excellent and good rate of 96.2%. Conclusion For patients with reverse Bennett fracture, good results can be obtained if early diagnose is done and appropriate internal fixation is selected.

Citation： ZHAO Min,TIAN Dehu,SHAO Xinzhong,LI Dacun,LI Jianfeng,LIU Jingda,ZHAO Liang,LI Hailei,WANG Xiaolei,ZHANG Wentong. DIAGNOSE AND TREATMENT OF INTRA-ARTICULAR FRACTURE OF FIFTH METACARPALE BASE WITH CARPOMETACARPAL JOINT DISLOCATION. Chinese Journal of Reparative and Reconstructive Surgery, 2013, 27(6): 662-665. doi: 10.7507/1002-1892.20130147 Copy

1.	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.
2.	Kataria H, Sharma N, Kanojia RK. Neglected, open, multiple carpal-metacarpal fracture dislocations of the hand—an unusual entity and its management. J Orthop Trauma, 2007, 21(8): 583-586.
3.	陈广先, 阚世廉, 张建兵. 第4、5掌骨基底骨折脱位的特点及治疗. 中国矫形外科杂志, 2011, 19(2): 147-149.
4.	赵椰枫, 王鸥, 章凯, 等. 第五腕掌关节二部分骨折脱位的临床疗效分析. 中国骨与关节损伤杂志, 2010, 25(9): 840-841.
5.	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.
6.	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.
7.	赵春鹏, 路来金, 刘志刚, 等. 带血管蒂第5腕掌关节移位的应用解剖学. 中国临床解剖学研究, 2002, 20(1): 48-50.
8.	王海明, 范存义, 姜佩珠, 等. 钩骨腕掌关节移位重建指骨间关节的解剖学基础研究. 中华关节外科杂志(电子版), 2010, 4(2): 233-238.
9.	王海明, 范存义, 姜佩珠, 等. 钩骨第5掌腕关节面的解剖学特征. 中国组织工程研究与临床康复, 2008, 12(15): 2866-2869.
10.	Yoshida R, Shah MA, Patterson RM, et al. Anatomy and pathomechanics of ring and small finger carpometacarpal joint injuries. J Hand Surg (Am), 2003, 28(6): 1035-1043.
11.	Pankaj A, Malhotra R, Bhan S. Isolated dislocation of the four ulnar carpometacarpal joints. Arch Orthop Trauma Surg, 2005, 125(8): 541-544.
12.	Chong AK, Chew WY. An isolated ring finger metacarpal shaft fracture?—beware an associated little finger carpometacarpal joint dislocation. J Hand Surg (Br), 2004, 29(6): 629-631.
13.	李强, 陈宇. 第五腕掌关节脱位合并腕尺管综合征1例. 实用手外科杂志, 2002, 16(3): 145.
14.	Figus A, Iwuagwu FC, Elliot D. Subacute nerve compressions after trauma and surgery of the hand. Plast Reconstr Surg, 2007, 120(3): 705-712.
15.	El-Shennawy M, Nakamura K, Patterson RM, et al. Three-dimensional kinematic analysis of the second through fifth carpometacarpal joints. J Hand Surg (Am), 2001, 26(6): 1030-1035.
16.	Al-Qattan MM. The triad of multiple metacarpal fractures and/or dislocations of the fingers, severe hand swelling and clinical evidence of acute median nerve dysfunction. J Hand Surg (Eur Vol), 2008, 33(3): 298-304.
17.	Thomas J. The exploded hand syndrome: logical evaluation and comprehensive treatment of the severely crushed hand. J Hand Surg (Am), 2006, 31(6): 1012-1023.
18.	闵晓辉, 王家琪, 高悠水, 等. 应用AO微型钛板治疗第5掌骨基底部骨折. 同济大学学报: 医学版, 2010, 31(3): 71-73.
19.	黄文海, 杨云峰. 应用微型钢板治疗第五掌骨基底部骨折. 海南医学, 2008, 19(11): 17-18.
20.	Souer JS, Mudgal CS. Plate fixation in closed ipsilateral multiple metacarpal fractures. J Hand Surg (Eur Vol), 2008, 33(6): 740-744.
21.	杨焕友, 李瑞国, 刘娜, 等. 微型钉板治疗第五掌骨基底骨折伴掌腕关节脱位疗效观察. 中国骨与关节损伤杂志, 2012, 27(5): 464-465.

1. 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.
2. Kataria H, Sharma N, Kanojia RK. Neglected, open, multiple carpal-metacarpal fracture dislocations of the hand—an unusual entity and its management. J Orthop Trauma, 2007, 21(8): 583-586.
3. 陈广先, 阚世廉, 张建兵. 第4、5掌骨基底骨折脱位的特点及治疗. 中国矫形外科杂志, 2011, 19(2): 147-149.
4. 赵椰枫, 王鸥, 章凯, 等. 第五腕掌关节二部分骨折脱位的临床疗效分析. 中国骨与关节损伤杂志, 2010, 25(9): 840-841.
5. 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.
6. 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.
7. 赵春鹏, 路来金, 刘志刚, 等. 带血管蒂第5腕掌关节移位的应用解剖学. 中国临床解剖学研究, 2002, 20(1): 48-50.
8. 王海明, 范存义, 姜佩珠, 等. 钩骨腕掌关节移位重建指骨间关节的解剖学基础研究. 中华关节外科杂志(电子版), 2010, 4(2): 233-238.
9. 王海明, 范存义, 姜佩珠, 等. 钩骨第5掌腕关节面的解剖学特征. 中国组织工程研究与临床康复, 2008, 12(15): 2866-2869.
10. Yoshida R, Shah MA, Patterson RM, et al. Anatomy and pathomechanics of ring and small finger carpometacarpal joint injuries. J Hand Surg (Am), 2003, 28(6): 1035-1043.
11. Pankaj A, Malhotra R, Bhan S. Isolated dislocation of the four ulnar carpometacarpal joints. Arch Orthop Trauma Surg, 2005, 125(8): 541-544.
12. Chong AK, Chew WY. An isolated ring finger metacarpal shaft fracture?—beware an associated little finger carpometacarpal joint dislocation. J Hand Surg (Br), 2004, 29(6): 629-631.
13. 李强, 陈宇. 第五腕掌关节脱位合并腕尺管综合征1例. 实用手外科杂志, 2002, 16(3): 145.
14. Figus A, Iwuagwu FC, Elliot D. Subacute nerve compressions after trauma and surgery of the hand. Plast Reconstr Surg, 2007, 120(3): 705-712.
15. El-Shennawy M, Nakamura K, Patterson RM, et al. Three-dimensional kinematic analysis of the second through fifth carpometacarpal joints. J Hand Surg (Am), 2001, 26(6): 1030-1035.
16. Al-Qattan MM. The triad of multiple metacarpal fractures and/or dislocations of the fingers, severe hand swelling and clinical evidence of acute median nerve dysfunction. J Hand Surg (Eur Vol), 2008, 33(3): 298-304.
17. Thomas J. The exploded hand syndrome: logical evaluation and comprehensive treatment of the severely crushed hand. J Hand Surg (Am), 2006, 31(6): 1012-1023.
18. 闵晓辉, 王家琪, 高悠水, 等. 应用AO微型钛板治疗第5掌骨基底部骨折. 同济大学学报: 医学版, 2010, 31(3): 71-73.
19. 黄文海, 杨云峰. 应用微型钢板治疗第五掌骨基底部骨折. 海南医学, 2008, 19(11): 17-18.
20. Souer JS, Mudgal CS. Plate fixation in closed ipsilateral multiple metacarpal fractures. J Hand Surg (Eur Vol), 2008, 33(6): 740-744.
21. 杨焕友, 李瑞国, 刘娜, 等. 微型钉板治疗第五掌骨基底骨折伴掌腕关节脱位疗效观察. 中国骨与关节损伤杂志, 2012, 27(5): 464-465.

Chinese Journal of Reparative and Reconstructive Surgery

DIAGNOSE AND TREATMENT OF INTRA-ARTICULAR FRACTURE OF FIFTH METACARPALE BASE WITH CARPOMETACARPAL JOINT DISLOCATION

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