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Dagi AF, Hong DY, Strauch RJ. Extra-Articular Base Fractures of the Proximal Phalanx in Adults: A Systematic Review. J Hand Surg Asian Pac Vol 2024; 29:49-58. [PMID: 38299241 DOI: 10.1142/s2424835524500085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2024]
Abstract
Background: Extra-articular proximal phalanx base fractures are common in adults and can lead to permanent finger stiffness and joint contractures. The purpose of this review is to summarise the evidence for operative and non-operative management of this fracture type. Methods: The MedLine, Embase, PubMed, Scopus and Cochrane Library databases were searched using the following key terms: 'proximal phalanx', 'base', 'fracture', 'repair' and 'fixation'. A total of 2,889 unique records were extracted. All studies with primary data on the management of extra-articular proximal phalangeal base fractures in adults were included for initial review. Results: Eleven studies met inclusion criteria with a total of 441 extra-articular proximal phalanx base fractures. Outcomes were determined by final total active range of motion. 182 extra-articular proximal phalangeal base fractures were treated non-operatively, with excellent or good outcomes attained in 80% of cases. Another 259 extra-articular proximal phalangeal base fractures were treated operatively, including 236 with Kirschner wires (K-wires), 18 with plates, and five with intramedullary screws. Case-level data were available in 186 fractures managed by K-wire fixation, with excellent or good outcomes achieved in 79% of cases. Excellent or good outcomes were achieved in 35% of cases treated by plates, and 80% of five cases treated by intramedullary screw fixation. Three (1.6%) patients managed conservatively required surgery after reduction loss. No patients managed with K-wires required re-operation for reduction loss; tenolysis/capsulotomy was required in 11 (4.5%) cases for stiffness, and pin site infections occurred in eight (3.5%) cases. Complex regional pain syndrome occurred in five cases (28%) of plate fixation. Conclusions: In summary, excellent or good results may be achieved by K-wire pinning or conservative management. Current evidence is limited for plate or intramedullary screw fixation. Prospective trials and outcomes standardisation are needed to improve the evidence base. Level of Evidence: Level III (Therapeutic).
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Affiliation(s)
- Alexander F Dagi
- Department of Orthopedic Surgery, NewYork-Presbyterian Hospital/Columbia University Medical Center, New York City, NY, USA
| | - Daniel Y Hong
- Department of Orthopedic Surgery, NewYork-Presbyterian Hospital/Columbia University Medical Center, New York City, NY, USA
| | - Robert J Strauch
- Department of Orthopedic Surgery, NewYork-Presbyterian Hospital/Columbia University Medical Center, New York City, NY, USA
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2
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Lambi AG, Rowland RJ, Brady NW, Rodriguez DE, Mercer DM. Metacarpal fractures. J Hand Surg Eur Vol 2023; 48:42S-50S. [PMID: 37704027 DOI: 10.1177/17531934231184119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/15/2023]
Abstract
Metacarpal fractures are common and can be functionally disabling. The majority are managed non-operatively. When surgical intervention is indicated, various methods of fixation are available with the utility of each being based on injury pattern, patient function and surgeon preference. Early mobilization, especially in case of open reduction and internal fixation, is a critical component of treatment to prevent stiffness and restore function. When possible, a fixation construct that can withstand the applied forces of early postoperative motion is chosen. We provide an updated description for diagnosis, treatment options and operative fixation for metacarpal fractures.
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Affiliation(s)
- Alex G Lambi
- University of New Mexico Department of Orthopaedics and Rehabilitation, Albuquerque, NM, USA
| | - Robert J Rowland
- Larkin Hospital Department of Orthopaedic Surgery, Coral Gables, FL, USA
| | - Nicholas W Brady
- University of New Mexico Department of Orthopaedics and Rehabilitation, Albuquerque, NM, USA
| | - Diego E Rodriguez
- University of New Mexico Department of Orthopaedics and Rehabilitation, Albuquerque, NM, USA
| | - Deana M Mercer
- University of New Mexico Department of Orthopaedics and Rehabilitation, Albuquerque, NM, USA
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3
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Kibar B, Cavit A, Örs A. A comparison of intramedullary cannulated screws versus miniplates for fixation of unstable metacarpal diaphyseal fractures. J Hand Surg Eur Vol 2022; 47:179-185. [PMID: 34107786 DOI: 10.1177/17531934211021521] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
We carried out a prospective randomized study to compare the clinical and radiological results of metacarpal diaphyseal fractures treated with retrograde intramedullary headless cannulated screws (IHCS) and plates. Fractures were fixed with IHCS in 34 patients (37 metacarpals) and locked miniplates in 35 patients (40 metacarpals). The mean age was 33 years (range 18-61) in the IHCS group and 32 years (range 17-68) in plate group. All patients were followed up for 1 year. All fractures in the IHCS group united but there was one nonunion in the plate group. At final follow-up, there was no significant difference between the groups in total active movement, visual analogue pain score, Disabilities of the Arm, Shoulder, and Hand score and grip strength, although the study was not sufficiently powered to exclude differences with certainty. IHCS is a safe and fast technique that is a good alternative to plate fixation in metacarpal diaphyseal fractures.Level of evidence: I.
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Affiliation(s)
- Birkan Kibar
- Haydarpaşa Numune Training and Research Hospital, Clinics of Orthopaedics and Traumatology, Istanbul, Turkey
| | - Ali Cavit
- Haydarpaşa Numune Training and Research Hospital, Clinics of Orthopaedics and Traumatology, Istanbul, Turkey
| | - Abdullah Örs
- Department of Anatomy, Kocaeli Üniversity, İzmit, Turkey
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4
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Gu S, Zhou L, Huang Y, Xie R. The curative effect analysis of a modified Kirschner wires and locking plate internal fixation method for the fifth metacarpal neck fracture. J Orthop Surg Res 2021; 16:491. [PMID: 34384465 PMCID: PMC8359124 DOI: 10.1186/s13018-021-02627-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Accepted: 07/24/2021] [Indexed: 11/10/2022] Open
Abstract
PURPOSE To evaluate the efficacy of a modified internal fixation method for the treatment of fifth metacarpal neck fracture. METHODS From March 2018 to December 2019, 12 patients with the fifth metacarpal neck fractures of the hands were treated with the Kirschner wires and locking plate internal fixation method. Each patient's gender, age, dominant hand, injured hand, trauma mechanism, preoperative and postoperative deformity (angulation and the length of the fifth metacarpal), the range of motion of the metacarpophalangeal joint and grip strength of each side, the time of return to work, and follow-up time were recorded and calculated. RESULTS The mean follow-up time was 16.8 months, and the angulations of preoperative and postoperative deformity were 40.0 ± 3.7°and 17.6 ± 1.7°, respectively. The length of the fifth metacarpals of preoperative and postoperative deformity were 51.5 ± 2.1 mm and 60.0 ± 1.8 mm, respectively. At the last follow-up, the range of motion of the fifth metacarpophalangeal joint of the injured side and the contralateral side were 84.3 ± 3.6°and 86.5 ± 2.0°, and the grip strength of the injured side and the contralateral side were 74.8 ± 6.1 LB and 78.6 ± 8.3 LB, respectively, without statistically significant differences. QDASH score was 2.0 ± 1.0, and the time of return to work was 6.0 ± 0.7 weeks. CONCLUSION The modified internal fixation method is one of the alternative treatments for the fifth metacarpal neck fracture with good curative effects.
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Affiliation(s)
- Song Gu
- Trauma Center, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, NO.650 Xin Songjiang Road, Shanghai, 201620, People's Republic of China
| | - Long Zhou
- Department of Obstetrics and Gynecology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, NO.650 Xin Songjiang Road, Shanghai, 201620, People's Republic of China
| | - Yinjun Huang
- Trauma Center, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, NO.650 Xin Songjiang Road, Shanghai, 201620, People's Republic of China
| | - Renguo Xie
- Trauma Center, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, NO.650 Xin Songjiang Road, Shanghai, 201620, People's Republic of China.
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5
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Tang JB, Wang ZT, Chen J, Wong J. A Global View of Digital Replantation and Revascularization. Clin Plast Surg 2020; 47:437-459. [PMID: 32892794 DOI: 10.1016/j.cps.2020.06.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Survival rates of digital replantation vary in different regions and countries, and Asian surgeons see more challenging cases and have developed some unique methods. Replantation of multiple digits in one or both hands can follow a structure-by-structure method or a digit-by-digit method. For replanting all 10 digits, 3 or 4 teams should be organized. Flow-through flaps, often venous flaps, can be taken from the distal forearm or lower extremity to repair defects of soft tissues and arteries. A pedicled digital artery flap from the adjacent digit can also repair tissue defects and supply blood to the replanted digit.
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Affiliation(s)
- Jin Bo Tang
- Department of Hand Surgery, Affiliated Hospital of Nantong University, Nantong, Jiangsu, China.
| | - Zeng Tao Wang
- Department of Hand and Foot Surgery, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, Shandong, China
| | - Jing Chen
- Department of Hand Surgery, Affiliated Hospital of Nantong University, Nantong, Jiangsu, China
| | - Jason Wong
- Department of Plastic and Reconstructive Surgery, The University of Manchester, Manchester, UK
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6
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Chen KJ, Wang JP, Yin CY, Huang HK, Chang MC, Huang YC. Fixation of fifth metacarpal neck fractures: a comparison of medial locking plates with intramedullary K-wires. J Hand Surg Eur Vol 2020; 45:567-573. [PMID: 31937179 DOI: 10.1177/1753193419896518] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Surgical treatment for metacarpal neck fractures may be indicated for malrotation, palmar angulation exceeding 30° or metacarpal shortening exceeding 3 mm, although these thresholds have not been firmly established. In a retrospective study, we compared the clinical and radiographic results of 54 patients with displaced fifth metacarpal neck fractures who were treated with either medial locking plates (14 patients) or retrograde intramedullary K-wires (40 patients). At a mean follow-up of 26 months (range 12 to 62), metacarpal shortening and angulation were 2 mm greater and 4° greater, respectively, in the K-wire group. The plate group had an earlier return to work and greater aesthetic satisfaction, but operative time and complication incidence were higher. Range of motion, time to union, grip strength and Quick Disability of the Arm, Shoulder and Hand scores were similar. We conclude that medial plating offers no clear advantage over K-wire fixation in treating metacarpal neck fractures. Level of evidence: III.
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Affiliation(s)
- Kuan-Jung Chen
- Department of Orthopaedics & Traumatology, Taipei Veterans General Hospital, Taipei, Taiwan.,Department of Surgery, National Yang-Ming University, Taipei, Taiwan
| | - Jung-Pan Wang
- Department of Orthopaedics & Traumatology, Taipei Veterans General Hospital, Taipei, Taiwan.,Department of Surgery, National Yang-Ming University, Taipei, Taiwan
| | - Cheng-Yu Yin
- Department of Orthopaedics & Traumatology, Taipei Veterans General Hospital, Taipei, Taiwan.,Department of Surgery, National Yang-Ming University, Taipei, Taiwan
| | - Hui-Kuang Huang
- Department of Orthopaedics & Traumatology, Taipei Veterans General Hospital, Taipei, Taiwan.,Department of Surgery, National Yang-Ming University, Taipei, Taiwan.,Department of Orthopaedics, Chiayi Christian Hospital, Chiayi, Taiwan.,Chung Hwa University of Medical Technology, Tainan, Taiwan
| | - Ming-Chau Chang
- Department of Orthopaedics & Traumatology, Taipei Veterans General Hospital, Taipei, Taiwan.,Department of Surgery, National Yang-Ming University, Taipei, Taiwan
| | - Yi-Chao Huang
- Department of Orthopaedics & Traumatology, Taipei Veterans General Hospital, Taipei, Taiwan.,Department of Surgery, National Yang-Ming University, Taipei, Taiwan
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7
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Abstract
In treating hand fractures, we have to make a proper decision about conservative treatment versus surgical intervention and decide on individual surgical methods. This article reviews recent publications, technical advances, and outcome measures in treating metacarpal fractures, phalangeal fractures, complex fractures of the proximal interphalangeal joints, bony mallet fingers, and fractures of the thumb. My personal preferences and considerations are presented. At the end, the current challenges that hand surgeons are facing in treating frequent phalangeal and metacarpal fractures are discussed.
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8
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Boeckstyns MEH. Questions about the treatment of the fractures around the fifth metacarpophalangeal joint. J Hand Surg Eur Vol 2020; 45:653-654. [PMID: 31550980 DOI: 10.1177/1753193419875899] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
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9
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Byrne B, Jacques A, Gurfinkel R. Non-surgical management of isolated proximal phalangeal fractures with immediate mobilization. J Hand Surg Eur Vol 2020; 45:126-130. [PMID: 31640468 DOI: 10.1177/1753193419881086] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
We performed a prospective, observational study using a non-surgical, conservative protocol with immediate mobilization for the treatment of 101 isolated stable or initially unstable proximal phalangeal fractures. The patients were evaluated at the time of discharge from therapy treatment, mean 7 weeks (range 3-15) after conservative treatment. These patients achieved a median proximal interphalangeal joint extension of -4° (IQR 0, -8), a mean total active motion of 253° (SD 20) and minimal pain. We conclude that a non-surgical, conservative protocol can be used for patients with isolated proximal phalangeal fractures without uncorrectable finger rotation or fracture angulation exceeding 25° in the sagittal plane or 10° in the coronal plane following closed reduction. Our data supports that a conservative protocol can be the good option for isolated stable or initially unstable proximal phalangeal fractures. Level of evidence: IV.
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Affiliation(s)
- Brent Byrne
- Department of Occupational Therapy, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia
| | - Angela Jacques
- Institute for Health Research, University of Notre Dame, Perth, Western Australia, Australia
| | - Reuven Gurfinkel
- Department of Plastic and Reconstructive Surgery, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia.,Faculty of Health and Medical Sciences, University of Western Australia Medical School, Perth, Western Australia, Australia
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10
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11
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Thomas BP, Raveendran S, Pallapati SR, Anderson GA. Augmented hamate replacement arthroplasty for fracture-dislocations of the proximal interphalangeal joints in 12 patients. J Hand Surg Eur Vol 2017; 42:799-802. [PMID: 28480780 DOI: 10.1177/1753193417707381] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
UNLABELLED We report clinical outcomes in 12 patients with hemi-hamate replacement arthroplasty combined with volar plate arthroplasty. The volar plate was reattached using trans-osseous sutures to reconstruct the ligament-box complex after hamate grafting to augment the stability of the proximal interphalangeal joint. Ten patients had improved joint movement from a mean of 14° before surgery to a mean of 77° at a minimum follow-up of 2 years. Grip strength and pain of the affected hand and patient-rated hand and wrist scores were improved in these 10 patients. Two patients had poor results. One patient developed ankylosis, and one patient had resorption of the grafted bone. We conclude that the augmented hamate replacement arthroplasty is useful in treating chronic proximal interphalangeal joint fracture-dislocations. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- B P Thomas
- Paul Brand Centre for Hand Surgery & Peripheral Nerve Surgery, Christian Medical College & Hospital, Vellore, India
| | - S Raveendran
- Paul Brand Centre for Hand Surgery & Peripheral Nerve Surgery, Christian Medical College & Hospital, Vellore, India
| | - S R Pallapati
- Paul Brand Centre for Hand Surgery & Peripheral Nerve Surgery, Christian Medical College & Hospital, Vellore, India
| | - G A Anderson
- Paul Brand Centre for Hand Surgery & Peripheral Nerve Surgery, Christian Medical College & Hospital, Vellore, India
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12
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Abstract
Hand fractures (excluding small avulsion fractures and scaphoid fractures) almost always unite with bone. The role of the hand surgeon is not to achieve bone union but to achieve stability in an adequate position, often with some displacement, and maintenance of good soft tissue gliding. This article establishes that many fractures treated operatively do no better and often could not realistically do better than with good nonoperative treatment. Yet many are treated surgically to satisfy surgical egos, the desire to produce excellent radiographs, or just the mistaken belief that current surgical techniques can improve on nonoperative treatment.
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Affiliation(s)
- Grey Giddins
- The Hand to Elbow Clinic, 29a James Street West, Bath BA1 2BT, UK.
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13
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Tang JB, Gong KT, Zhu L, Pan ZJ, Xing SG. Performing Hand Surgery Under Local Anesthesia Without a Tourniquet in China. Hand Clin 2017; 33:415-424. [PMID: 28673619 DOI: 10.1016/j.hcl.2017.04.013] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
In China, wide-awake surgeries are increasingly used by surgeons in a growing number of hospitals for hand and upper extremity surgeries. Experience suggests that wide-awake surgery is safe, economical, and patient-friendly, optimizing hospital resource allocation and increasing efficiency. This article discusses which procedures are most suitable, variations in procedures, departmental impacts, and future direction.
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Affiliation(s)
- Jin Bo Tang
- Department of Hand Surgery, The Hand Surgery Research Center, Affiliated Hospital of Nantong University, Nantong, Jiangsu, China.
| | - Ke Tong Gong
- Department of Hand Surgery, Tianjing Hospital, Tianjing, China
| | - Lai Zhu
- Hand Surgery, Qilu Hospital of Shandong University, Jinan, Shandong, China
| | - Zhang Jun Pan
- Department of Surgery, Yixing People's Hospital, Yixing, Jiangsu, China
| | - Shu Guo Xing
- Department of Hand Surgery, The Hand Surgery Research Center, Affiliated Hospital of Nantong University, Nantong, Jiangsu, China
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14
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Sun YC, Sheng XM, Chen J, Qian ZW. In vivo metacarpophalanageal joint collateral ligament length changes during flexion. J Hand Surg Eur Vol 2017; 42:610-615. [PMID: 28488458 DOI: 10.1177/1753193417692708] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
We investigated the in vivo length changes of the collateral ligaments of metacarpophalangeal joint during flexion. We obtained computed tomography scans of index, middle, ring and little fingers at 0°, 30°, 60° and 90° of joint flexion from six hands of six healthy adult volunteers. Three of them had their dominant right hand studied, and the other three had their non-dominant left hand studied. We measured and analysed the radial and ulnar collateral ligaments of each metacarpophalangeal joint from the reconstructed images. We found that the dorsal and middle portions of the both radial and ulnar collateral ligament lengthened progressively during digital flexion and reached the maximum at 90° flexion. The length of the volar portion increased from 0° to 30° flexion and then decreased from 30° to 60° flexion, reaching the minimum at 90°. In conclusion, three portions of collateral ligaments on both sides of the metacarpophalangeal joint have variable length changes during flexion, which act to stabilize the joint through its flexion arc.
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Affiliation(s)
- Y C Sun
- Department of Hand Surgery, Affiliated Hospital of Nantong University, Nantong, Nantong University, Jiangsu, China
| | - X M Sheng
- Department of Hand Surgery, Affiliated Hospital of Nantong University, Nantong, Nantong University, Jiangsu, China
| | - J Chen
- Department of Hand Surgery, Affiliated Hospital of Nantong University, Nantong, Nantong University, Jiangsu, China
| | - Z W Qian
- Department of Hand Surgery, Affiliated Hospital of Nantong University, Nantong, Nantong University, Jiangsu, China
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15
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Tang JB, Wang ZT, Chen J, Wong J. A Global View of Digital Replantation and Revascularization. Clin Plast Surg 2017; 44:189-209. [DOI: 10.1016/j.cps.2016.11.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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16
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Abstract
Hand fracture fixation in mutilating injuries is characterized by multiple challenges due to possible skeletal disorganization and concomitant severe injury of soft tissue structures. The effects of skeletal disruption are best analyzed as divided into specific locales in the hand: radial, ulnar, proximal, and distal. Functional consequences of injuries in each of these regions are discussed. Although a variety of implants are now in vogue, K-wire fixation has stood the test of time and is especially useful in multiple fracture situations. Segmental bone loss is quite common in such injuries, which can be safely reconstructed in a staged manner.
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Affiliation(s)
- Praveen Bhardwaj
- Department of Plastic, Hand & Reconstructive Microsurgery and Burns, Ganga Hospital, 313, Mettupalayam Road, Coimbatore, Tamil Nadu 641 043, India
| | - Ajeesh Sankaran
- Department of Plastic, Hand & Reconstructive Microsurgery and Burns, Ganga Hospital, 313, Mettupalayam Road, Coimbatore, Tamil Nadu 641 043, India
| | - S Raja Sabapathy
- Department of Plastic, Hand & Reconstructive Microsurgery and Burns, Ganga Hospital, 313, Mettupalayam Road, Coimbatore, Tamil Nadu 641 043, India.
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17
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Kim JH, Kwon SS, Moon SJ, Choe JS, Kwak HI, Lee SY, Le HJ, Kim JY. Reliability of classification of ring and little finger carpometacarpal joint fracture subluxations: a comparison between two-dimensional computed tomography and three-dimensional computed tomography classifications. J Hand Surg Eur Vol 2016; 41:448-52. [PMID: 26329885 DOI: 10.1177/1753193415602589] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2014] [Accepted: 06/09/2015] [Indexed: 02/03/2023]
Abstract
The aims of this study were to develop a classification for ring and little finger carpometacarpal joint fracture subluxations based on three-dimensional computed tomography images and evaluate the inter- and intraobserver reliability of the three-dimensional computed tomography classification. A retrospective review was performed of 30 cases of ring and little finger carpometacarpal joint fracture subluxations from 2005 to 2013. We classified ring and little finger carpometacarpal joint fracture subluxations into three types based on three-dimensional computed tomography images. An orthopaedic surgeon with 2 years of experience, a consultant hand surgeon with 8 years of experience, and a consultant radiologist with 9 years of experience, who were completely blind to the treatment algorithm, evaluated 30 cases twice at a 2-week interval using our new classification based on three-dimensional computed tomography images and the other classification based on two-dimensional computed tomography images. Our three-dimensional computed tomography classification showed almost perfect interobserver and intraobserver reliability and resulted in a better level of agreement than two-dimensional computed tomography classification.
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Affiliation(s)
- J H Kim
- Department of Orthopedic Surgery, Seonam University College of Medicine, Myongji Hospital, Goyang - Si, Korea
| | - S-S Kwon
- Biomedical Research Institute, Seoul National University Bundang Hospital, Seoul, Korea
| | - S J Moon
- Department of Orthopedic Surgery, Seonam University College of Medicine, Myongji Hospital, Goyang - Si, Korea
| | - J S Choe
- Department of Orthopedic Surgery, Seonam University College of Medicine, Myongji Hospital, Goyang - Si, Korea
| | - H I Kwak
- Department of Orthopedic Surgery, Seonam University College of Medicine, Myongji Hospital, Goyang - Si, Korea
| | - S Y Lee
- Department of Orthopedic Surgery, Ewha Womans University Mokdong Hospital
| | - H J Le
- Department of Radiology, Konkuk University School of Medicine
| | - J Y Kim
- Department of Orthopedic Surgery, Seonam University College of Medicine, Myongji Hospital, Goyang - Si, Korea
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