Dorsal Spanning Plating for Complex Carpometacarpal Fracture-dislocations

Carpometacarpal (CMC) fracture-dislocations represent only 1% of all hand injuries. Up to 70% were misdiagnosed due to severe soft tissue swelling and overlapping of carpal bones on the radiograph. Due to its unstable nature, operative treatment is usually indicated and there is still no consensus on the fixation method after reduction. In our case series, we used dorsal spanning plate fixation after open reduction and the functional, radiographic outcomes and complications were reviewed and analyzed.  

We retrospectively reviewed our patients who underwent open reduction and internal fixation with dorsal spanning plate at a tertiary referral center from September 2015 to January 2023.We enrolled 10 patients who at age over 20, with at least one year follow up. All of them had CMC fracture-dislocations due to trauma and underwent dorsal spanning plating through dorsal approach. Clinical outcomes were evaluated at 6 weeks, at 3 and 6 months, at 1 year, and annually thereafter. Functional outcome of Visual analogue scale (VAS), Disabilities of the Arm, Shoulder and Hand Outcome Measure (DASH) and grip strength compared to non-affected hand were analyzed.

All patients included in our study were male with an average of 32 years (range: 20-42 years). Of all the nine patients, 4 (44%) were caused by motorcycle traffic accident, two (22%) by falling accident, two (22%) during sport activity and one (14%) due to crush injury at work. Three of nine were delayed presentation. At final follow-up, the median VAS, DASH and hand grip strength were 0 (range 0-1), 0 (range, 0-15.9) and 89.4% (range, 81.5-110.4%), respectively. In terms of the complications, there were 3 patients with implant breakage, but it seemed not highly correlated to the functional outcomes. On the final radiograph studies, there was no visible re-dislocation, shortening or non-union. The union time ranges from 3-6 months.

Our present study suggests that Dorsal spanning plating may be an alternative treatment option for CMC fracture-dislocations even delayed presentation with substantial metacarpal shortening.

Keywords: Carpometacarpal, Fracture-dislocations, plating