Treatment of fracture-dislocation of the hamate-metacarpal articulation with across-joint internal fixation using the bridging plate technique

LI Zhong-zhe; GAO Yong-bin; TIAN Guang-lei

doi:10.3969/j.issn.2095-252X.2017.04.004

Abstract：Objective To introduce the clinical application results and surgical technique in the treatment of fracture-dislocation of the hamate-metacarpal articulation with across-joint internal fixation using the bridging plate technique. Methods From August 2008 to December 2015, 55 cases of fracture-dislocation of the hamate-metacarpal articulation were treated with this kind of method and followed up. According to Cain type, there were 8 cases of type I A, 27 cases of type I B, 13 cases of type Ⅱ and 7 cases of type Ⅲ. Open reduction and across-joint internal fixation were performed on fracture-dislocation of the hamate-metacarpal articulation using a 2.3mm Stryker bridging plate, as well as fixation of the 4th and 5th carpometacarpal joint. Early motion was allowed after the operation. The plate was removed at 4 months after the operation. Results All the cases were followed up for an average period of 2.5 years ( range: 6 - 48 months ). Fracture union was achieved successfully in all the cases, and the average union time was 5.5 weeks. Function evaluation was made according to pain degree and flexor and extensor activity of the wrist joint. There were 39 excellent cases, 14 good cases, 2 fair cases and 0 poor case. The overall excellent and good rate was 96.3%, and the clinical results were satisfactory without severe complications or recurrence of dislocation. Conclusions Treatment of fracture-dislocation of the hamate-metacarpal articulation with across-joint internal fixation using the bridging plate technique is better than conventional methods. This technique avoids redislocation and instability of the hamate-metacarpal joint. It is allowed to begin early active motion of the wrist joint, and meanwhile strong and stable fixation can be achieved. Postoperative joint pain can be relived and limited joint activity can be avoided. It is an effective method in treatment of fracture-dislocation of the hamate-metacarpal articulation.