Unstable Hamatometacarpal Fracture-Dislocation : Classification and Treatment

Journal of the Korean Society for Surgery of the Hand 1999;4(1):19-28.
Published online January 1, 1999.

Moon Sang Chung,Deuk Soo Jun,Goo Hyun Baek,Byoung Wan Ahn,Jae Hoon Shin

불안정 유구 중수 골절-탈구 : 분류와 치료

정문상,전득수,백구현,안병완,신재훈

Abstract

There has been few reports on hamatometacarpal fracture-dislocation. We experienced 8 cases of unstable hamatometacarpal fracture-dislocation that were treated with open reduction and internal fixation; 3 cases of hamato-metacarpal(5th) fracture-dislocation, and 5 cases of hamato-metacarpal(5th) fracture-dislocation with associated fracture of 4th metacarpal. All 3 cases of hamato-metacarpal(5th) fracture-dislocation were reduced anatomically by open reduction and fixation of the fracture fragment of hamate. In four out of 5 cases which showed associated 4th metacarpal fracture, however, hamato-metacarpal(4th) joint was still unstable even after reduction and fixation of the fractured hamate. Additional transmetacarpal or carpometacarpal K-wire fixations were done to stabilize hamato-metacarpal(4th) joint in these cases. From our experiences, we categorized the fracture-dislocation into 2 types - type I: fracture-dislocation of hamato-metacarpal(5th) joint, and type II: fracture-dislocation of hamato-metacarpal(5th) joint associated with fracture of 4th metacarpal. Type II was further classified as type IIA which has stable fracture of 4th metacarpal, and type IIB which has unstable fracture of 4th metacarpal and need further fixation of this unstable 4th metacarpal.