Fifth carpometacarpal fracture dislocations fixed with Meta-HUS®: a series of 31 cases

Hideaki Miyamoto, Mohamed Adi, Chihab Taleb, Ahmed Zemirline, Frédéric Bodin, André Gay, Sybille Facca, Philippe Liverneaux

Fracture dislocations of the fifth carpometacarpal are usually treated by percutaneous K-wires despite occasional complications: displacement, stiffness, malunions, and arthritis. Our aims were to evaluate the use of locked K-wire fixation for these fracture dislocations. Our series includes 31 fracture dislocations, five extra-articular and 26 articular, 21 of which were at the base of the metacarpal, four at the hamate, and one involving both the hamate and the metacarpal. Mean tourniquet time was 22 min and irradiation 2 mGy. After reduction, an M4 M5 K-wire and a carpometacarpal wire were connected using an MetaHUS (®) connector. Immediate immobilization was allowed. Return to normal activity was resumed at 6.5 weeks. At around 15 months follow-up, mean pain score was 8.5, Quick DASH was 6.36, and overall grip strength was 92 %, TAM of the fifth ray was 96 % of the contralateral side. There were two displacements that were re-operated with good result, three superficial infections, and one case of stiffness. All fractures healed without arthritis. Overall, percutaneous K-wire and splinting of fracture dislocations of the fifth carpometacarpal joint is unstable, and internal fixation can cause adhesions and stiffness. Our results show that the percutaneous locked K-wire technique is a good alternative as it associates closed reduction with K-wire fixation and a solid fixation using an external connector. This technique allows immediate mobilization of the hand and removal of hardware in clinic.