BODYCAST - THE OFFICIAL JOURNAL OF THE CSOT

Axial ulnar carpometacarpal disruption

By A.J. Laing and J.P. McCabe
Reprinted with permission from Injury, Int. J. Care Injured, 34 (2003), 537-539.

Intoduction

Carpal injuries resulting form antero-posterior compression forces demonstrate unusual axial fracture-dislocation patterns. This distinctive injury was first described by Oberst in 1901, and involves a traumatic longitudinal disruption of the carpus and its respective metacarpals. Flexor retinaculum disruption permitting flattening of the carpal arch is common to all these injuries. Ogunru (1983) and Norbeck, Larson, Blair and Demos (1987), however, reported cases of incomplete axial disruption, where the proximal carpal row and flexor retinaculum remain intact. No subsequent cases have been discovered in the literature. In this report, we describe a further case of an incomplete axial-ulnar carpometacarpal disruption with an oblique fracture of the body of the hamate and an intact proximal carpal row.

Case Report:
A 26-year-old man presented following a motorcycle accident with a crush injuries to his left non-dominant hand. On initial examination, there was generalized swelling of the left hand and wrist. There was no clinical angular or rotational deformity of the digits. Apart from superficial abrasions, the overlying skin was intact. There was no neurovascular deficit or clinical evidence of tendon disruption.

Routine radiographs of the injured hand revealed diastasis of the articulation between the third and fourth metacarpals and an oblique fracture through the body of the hamate. These were fractures through the body of the hamate. There were fractures through the bases of the second and third metacarpals and through both radial and ulnar styloid processes. The carpal arcs were radiologically intact.

The unstable metacarpal fractures were stabilized with transverse percutaneous Kirschner wires and the wrist and hand were immobilized in a volar splint for four weeks. At this stage, the wires were removed and an intensive physiotherapy rehabilitation program was commenced. At six months post-surgery, the patient was pain-free and had returned to work. His grip strength was measured at 48kg (56kg on the uninjured dominant side). His wrist movement were: palmar flexion 75 o, dorsiflexion 70 o, ulnar deviation 35 o, radial deviation 5 o, pronation 85 o, suppination 90 o.

Plain radiographs showed a near normal appearance of the carpus at this stage with healing of the hamate fracture.

This abstract is a portion of the article which appears in the Spring 2005 issue of BodyCast.  
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