제 4,5 수근중수골간 관절 아탈구를 동반한 유구골 체부 골절의 수술적 치료

Abstract

Purpose: Fracture of the hamate body with associated dorsal dislocation of the 4th and 5th carpometacarpal joints is rare and the diagnosis is frequently missed. Displaced carpal fractures requires anatomical reduction to restore normal carpal kinematics and obtain good outcome. We present the clinical and radiological results of the open reduction and internal fixation for hamate body fractures with concomittant 4th and 5th carpometacarpal joint dislocation. Materials and Methods: From Jan. 2003 to Dec. 2007, we experienced 10 cases of carpal bone fractures with ulnar carpometacarpal joint dislocation that underwent open reduction. Two cases had dorsal capitate and hamate fractures, and the other eight cases had dorsal hamate fractures with dislocation of the bases of the 4th and 5th metacarpals in all 10 cases. Treatment consisted of open reduction through dorsal approach and internal fixation with mini bone screw followed by splint application and immediate range of motion exercise. Bone union was evaluated with follow up x-ray and clinical evaluation was performed with grip strength, wrist and finger range of motion, and the degree of pain. Results: The mean follow up period was 12.3 months. All cases showed bony union at the average of seven weeks postoperatively. All cases achieved excellent range of motion. Grip strength were normal compared to the other side. Two cases had internittent pain as a complication. Conclusion: The diagnosis should be suspected on initial review of plain radiographs in any patient presenting with pain after blunt trauma to the hand. The operative treatment was required in cases with difficulty in maintaining closed reduction, open displaced fractures, and delayed diagnosis. Open reduction and internal fixation resulted in good clinical and radiological outcomes.