Thursday, September 30, 2010

Postoperative Management of CMC Joint Fracture Dislocation of the Hand

I haven’t seen or treated any wrist dislocation injuries since my hand surgery fellowship, but still read an article regarding their treatment every now and then. I stumbled across this one (full reference below) via MDLinx. The full article is available for free online.

The authors of the article note in their literature search that most multiple carpometacarpal (wrist) fracture/dislocation injuries are due to motor vehicle accidents. They were unable to find any large studies of multiple CMC dislocations. One of the “largest” had only 10 patients.

Multiple CMC dislocations are uncommon and occur from high-energy trauma. Treatment of these injuries require operative fixation. The reduced fractures/dislocations are stabilized using K-wires which remain in place for 6-8 weeks.

Prolonged immobilization can result in stiffness of hand joints, tendon adhesions, and muscle weakness. The authors of the CJPS article note that early controlled motion must be balanced with sufficient immobilization of the fractures/dislocations to allow healing.

The main purpose of their case presentation is to describe a novel postoperative rehabilitation regimen in their multiple CMC fracture dislocation patient (a 28 yo male).

The wrist and hand were immobilized in the neutral position for two weeks in a short arm splint and for an additional four weeks in a short arm circumferential cast.

The Kirscher wires were removed at the outpatient clinic at eight weeks. Radiographs confirmed union…

Hand therapy, consisting of protective splinting and active-assisted ROM, was initiated eight week following injury. ….

Hand therapy was then progressed to the use of a novel circumferential carpal stabilization brace that the patient wore at all times. The carpal brace extended from the metacarpal heads to the radiocarpal joint. This permitted movement of the radiocarpal and metacarpal joints, while firmly supporting the CMC articulations. Following removal of the cast, the brace was worn at all times. ……

REFERENCE

Postoperative management of carpometacarpal joint fracture dislocation of the hand: A case report; T Bell, SJ Chinchalkar, K Faber; Canadian Journal of Plastic Surgery, Autumn 2010, Volume 18 Issue 3: e 37-e 40

Carpometacarpal Fracture Dislocation; Wheeless’ Textbook of Orthopaedics (accessed Sept 16, 2010)

Hand, Metacarpal Fractures and Dislocations; eMedicine Article, August 20, 2009; James Neal Long, MD, James A Chambers, MD, MPH, Jorge I de la Torre, MD, FACS,

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