Is It Possible to Perform Fifth Carpometacarpal Joint Arthroscopy? Cadaveric Study on Its Feasibility, Safety, and Potential Hazards in Portal Creation

2022 ◽  
Author(s):  
Siu Cheong Jeffrey Justin Koo ◽  
Henry Pang ◽  
Pak Cheong Ho
Keyword(s):  
Spatial Relationship ◽  
Ring Finger ◽  
Fracture Dislocation ◽  
Joint Surface ◽  
Carpometacarpal Joint ◽  
Level Of Evidence ◽  
Rare Injury ◽  
Anatomical Dissection ◽  
Body Fracture ◽  
Little Finger

Abstract Background Fifth carpometacarpal joint (CMCJ) fracture dislocation is a relatively rare injury and most will require operative treatment because of its unstable nature. Improper reduction and fixation lead to joint surface destruction, pain, and reduced grasping power. Intra-articular fragment reduction is often obscured by dorsally displaced ulnar fragment. Therefore, fifth CMCJ arthroscopy can be advantageous in assisting intra-articular fragment reduction. However, there is no detailed description of the portal landmarks or portals' relationship with adjacent important structures in the literature. Purposes To explore the feasibility and safety of fifth CMCJ arthroscopy, locations of the portals are examined in cadaveric hand specimens. Their proximity to important anatomical structures such as dorsal cutaneous branch of ulnar nerve (DCBUN), ring finger and little finger extensor digitorum communis (EDC), and extensor digiti minimi (EDM) is measured. Methods Fifth CMCJ arthroscopy is performed on 11 cadaveric hand specimens by specialist-level surgeon. The portals are marked and portal positions are further confirmed under the fluoroscopy. Then the cadaveric specimens were undergone anatomical dissection by specialist-level surgeon. During dissection, the spatial relationship between the portal positions and DCBUN, EDC to ring finger and little finger, and EDM is identified. The distance between the portals and the above important structures was measured in millimeters. Results DCBUN was consistently found between fourth metacarpohamate (4-MH) and fifth metacarpohamate (5-MH) portals, with it being closer to the latter (mean distance, 2.03 mm; range, 0–4.43 mm; standard deviation [SD], 1.09 mm). The closest tendon for 4-MH portal is ring finger EDC (mean distance, 2.65 mm; range, 0–5.89 mm; SD, 1.78 mm), while 5-MH portal and accessory portal were closest to EDC (mean distance, 1.88 mm; range, 0–3.69 mm; SD, 1.25 mm) and EDM (mean distance, 7.79 mm; range, 6.63–10.72 mm; SD, 1.49 mm), respectively. During the process of specimen dissection, we found no damage to the above structures after portal introduction. Conclusion The above findings support the use of fifth CMCJ arthroscopy, which can be used for assisted reduction in fifth metacarpal base fracture dislocation and hamate body fracture. Gentle soft tissue spreading technique during portal creation prevents injury to the important structure surrounding the portals. Level of evidence This is a Level V study.

Arthrodesis of Ring Finger and Little Finger Metacarpal Bases for Little Finger Carpometacarpal Joint Arthritis

2004 ◽  
Vol 29 (5) ◽  
pp. 449-452 ◽  
Author(s):  
GREGORY I. BAIN ◽  
P.M. RAGHAVAN UNNI ◽  
JANAK A. MEHTA ◽  
MICHAEL H.A. EAMES
Keyword(s):  
Pain Relief ◽  
Daily Living ◽  
Ring Finger ◽  
Carpometacarpal Joint ◽  
Interposition Arthroplasty ◽  
Finger Length ◽  
Capsular Flap ◽  
Good Cosmesis ◽  
Joint Arthritis ◽  
Little Finger

Five patients with localized little finger carpometacarpal arthritis were treated by excision of the little finger metacarpal base and arthrodesis of the little and ring metacarpals. A dorsal periosteal/capsular flap was used as an interposition graft. All patients achieved significant pain relief, good cosmesis and satisfactory grip strength. All returned to activities of daily living. This procedure, the Dubert procedure, is indicated for localized pathology of the hamate-little finger metacarpal joint. It has theoretical advantages over arthrodesis and resection or interposition arthroplasty as it preserves little finger length, rotation and alignment and maintains some mobility of the transverse carpal arch and the little finger ray.

An Isolated Ring Finger Metacarpal Shaft Fracture? – Beware An Associated Little Finger Carpometacarpal Joint Dislocation

2004 ◽  
Vol 29 (6) ◽  
pp. 629-631 ◽  
Author(s):  
ALPHONSUS K. S. CHONG ◽  
WINSTON Y. C. CHEW
Keyword(s):  
Ring Finger ◽  
Shaft Fracture ◽  
Metacarpal Fracture ◽  
Carpometacarpal Joint ◽  
Joint Injury ◽  
Joint Dislocation ◽  
Radiological Features ◽  
Metacarpal Shaft ◽  
Joint Dislocations ◽  
Little Finger

Dislocations of the ulnar carpometacarpal joint are easily missed because of a low index of suspicion as well as their subtle clinical and radiological features. Often, the presence of a more obvious adjacent injury also draws attention away from the carpometacarpal joint. Two cases of ring finger metacarpal shaft fractures with associated little finger carpometacarpal joint dislocations are presented. In both cases, the metacarpal fractures were diagnosed but the carpometacarpal joint dislocations were initially overlooked. The presence of an apparently isolated ring finger metacarpal fracture due to an indirect force should raise the possibility of an associated carpometacarpal joint injury.

Fracture-dislocations of the carpometacarpal joints of the ring and little finger

2014 ◽  
Vol 40 (1) ◽  
pp. 84-87 ◽  
Author(s):  
S. V. Gehrmann ◽  
R. A. Kaufmann ◽  
J. P. Grassmann ◽  
T. Lögters ◽  
M. Schädel-Höpfner ◽  
...  
Keyword(s):  
Closed Reduction ◽  
Open Reduction ◽  
Carpometacarpal Joint ◽  
Level Of Evidence ◽  
Carpometacarpal Joints ◽  
Functional Differences ◽  
Pin Fixation ◽  
Fracture Dislocations ◽  
Little Finger

We report the functional and radiographic results of 16 patients with fracture-dislocations of the ring and little finger carpometacarpal joints and 23 cases with fracture-dislocations of only the little finger carpometacarpal joint treated between 2006 and 2012. The above two cohort populations of patients were treated with either open reduction and pin fixation or closed reduction and pin fixation. These patients were followed for a mean of 13 months (range 9 to 48). The DASH scores for patients with fracture-dislocations of the ring and little finger carpometacarpal joints were 6.0 and of the little finger carpometacarpal joint 7.2. We found no functional differences in term of DASH scores after treatment between patients with fracture-dislocations of only the little finger carpometacarpal joint and both the ring and little finger carpometacarpal joints. Level of evidence: IV

Predisposing Factors for Posttraumatic Osteoarthritis After Malleolus Fracture Fixation in Patients Younger Than 50 Years

2021 ◽  
pp. 107110072110500
Author(s):  
Jong Seok Beak ◽  
Yeong Tae Kim ◽  
Sung Hyun Lee
Keyword(s):  
Risk Factors ◽  
Articular Surface ◽  
Binary Logistic Regression ◽  
Ankle Fractures ◽  
Fracture Dislocation ◽  
Posttraumatic Arthritis ◽  
Level Of Evidence ◽  
Posttraumatic Osteoarthritis ◽  
Posterior Malleolus

Background: The purpose of this study was to identify the risk factors for posttraumatic osteoarthritis (OA) after surgery for ankle fractures in patients aged ≤50 years. Methods: We performed a retrospective review of consecutive patients who underwent surgery for ankle fractures and were followed up for a minimum period of 5 years. The patients were assigned to 2 groups according to the presence of advanced OA at the last follow-up. Binary logistic regression was used to model the correlation between risk factors and OA. Functional outcomes were assessed using the Foot and Ankle Outcome Score. Results: The data of 332 patients who met the inclusion criteria were included in the analysis. The overall rate of posttraumatic arthritis was 27.7% (nonarthritis group: 240 patients, arthritis group: 92 patients). The arthritic change was significantly affected by BMI (95% confidence interval [CI] 1.29-19.76; adjusted odds ratio [OR] ≥ 30, 6.56), fracture-dislocation injury (CI 1.66-11.57; adjusted OR, 4.06), posterior malleolus (PM) fracture (CI 1.92-12.73, adjusted OR > 25% of the articular surface, 5.72), and postoperative articular incongruence (CI 1.52-18.10; adjusted OR, 7.21). The mean scores of the arthritis group were lower than those in the nonarthritis group ( P < .05). Conclusion: Obesity, fracture-dislocation injury, concomitant large PM fracture, and articular incongruence were risk factors of posttraumatic OA after surgery for ankle fractures. Surgeons should be aware that accurate reduction is critical in patients with ankle fractures with associated large PM fractures, especially those with obesity or severe initial injuries such as fracture-dislocation. Level of Evidence: Level III, case control study.

scholarly journals Bilateral anatomical variations of the hand extensors

2016 ◽  
Vol 15 (2) ◽  
pp. 278-282
Author(s):  
Humberto Ferreira Arquez
Keyword(s):  
Anatomical Variation ◽  
Medical Science ◽  
Ring Finger ◽  
Anatomical Variations ◽  
Extensor Digitorum ◽  
Left Hand ◽  
Extensor Tendons ◽  
Right Hand ◽  
The Right ◽  
Little Finger

Background: The purpose of this paper is to describe an anatomical variation of the hand extensor on the little finger of the right hand which receives four tendons, condition unknown, as it is the first case reported so far in the literature. The human extensor tendons of hand often display an array of variations. Awareness of the anatomy and variations of the extensor tendons on the dorsum of the hand is necessary not only for the anatomist but also for surgeons when considering tendons for hand surgery, tendon rerouting or transplants. Materials and Methods: Bilateral anatomical variation in the upper limb was found during routine dissection in a 75-year-old male cadaver in the Morphology Laboratory at the University of Pamplona. The variations were recorded and photographed. Result: In the left hand the extensor digitorum there was a single tendon to the index, double tendon to the middle, triple tendon to the ring finger, a single tendon to the little finger or digiti minimi. The extensor digiti minimi has double tendon. In the right hand the extensor digitorum there was a single tendon to the index, triple tendon to the middle finger, triple tendons to the ring finger, a double tendon to the little finger. The extensor digiti minimi has double tendon. The little finger receives four tendons, 2 of extensor digitorum and 2 of extensor digiti minimi. The dorsum of the left hand and right showed juncturae tendinum type 2, between the extensors tendons in the 3rd intermetacarpal space; type 3, between the extensors tendons in the 4th inter metacarpal space. Conclusion: The presence of multiple tendons may alter the kinematics around the site of attachment to the phalanx. Knowledge of anatomical variations and normal anatomy of the extensor tendons, may be helpful while performing graft and tendon transfer operations.Bangladesh Journal of Medical Science Vol.15(2) 2016 p.278-282

scholarly journals Posterior malleolar fractures. New classification and treatment algorithm

2020 ◽  
Vol 14 (3) ◽  
pp. 254-259
Author(s):  
Diego Yearson ◽  
Ignacio Melendez ◽  
Federico Anain ◽  
Santiago Siniscalchi ◽  
Juan Drago
Keyword(s):  
Posterior Approach ◽  
Treatment Algorithm ◽  
Case Series ◽  
Fracture Pattern ◽  
Joint Surface ◽  
Medial Malleolus ◽  
New Classification ◽  
Level Of Evidence ◽  
Malleolar Fractures ◽  
Posterior Malleolus

Objective: This study proposes a new classification of posterolateral malleolar fractures and a treatment algorithm. Methods: We divided the posterolateral malleolus, which we considered as the posterior malleolus, from the posteromedial one, which we considered as being part of the medial malleolus fracture. The experience with 77 patients treated from February 2017 to February 2020 was assessed. All of them were assessed by frontal and profile radiographies and computed tomography (CT). Among the parameters to classify these fractures, we believe the most determining ones are fracture size, followed by presence of fracture displacement. Results: Fractures were divided into those whose posterior fragment was 25% smaller than the tibial joint surface and those that compromised more than 25% of this joint. The first group underwent syndesmotic opening and was subclassified into 1A (stable fractures), which do not require surgical treatment, and 1B (unstable), which require syndesmotic stabilization. The second group, which comprised the larger fractures, was subclassified into 2 A (non-displaced fractures, or with a displacement below 2 mm), which underwent percutaneous osteosynthesis, 2B (displaced fractures), and 2C (comminuted fractures), which underwent open reduction and internal fixation using a posterior approach. Conclusion: The classifications published so far are anatomic or descriptive, but none of them proposes a therapeutic algorithm for each type of fracture. We believe it will be helpful for its interpretation and decision-making on the need to perform a posterior approach, prioritizing the anatomical reduction of the joint fragment and resolution of syndesmotic instability linked to each fracture pattern using the most simple and effective method. Level of Evidence IV; Therapeutic Studies; Case Series.

scholarly journals Open anterolateral fracture dislocation of ankle joint: a rare case report

2018 ◽  
Vol 5 (1) ◽  
pp. 192
Author(s):  
Prasanna Anaberu ◽  
R. Prathik ◽  
R. Manish
Keyword(s):  
Ankle Joint ◽  
Fracture Fixation ◽  
Road Traffic ◽  
Emergency Operation ◽  
High Energy ◽  
Fracture Dislocation ◽  
Anterior Dislocation ◽  
Malleolar Fracture ◽  
Rare Injury ◽  
Wound Debridement

<p class="abstract">Anterior ankle dislocation with associated compound bi-malleolar fracture is a rare injury. Ankle fracture dislocations most frequently occurs in young males caused by high energy trauma. The direction of the joint dislocation is determined by the position of the foot and the direction of the force being applied. A middle aged male presented to us with history of road traffic accident and was diagnosed to have anterior dislocation of right ankle joint with compound bi-malleolar fracture. Patient was taken to emergency operation theatre for wound debridement and immediate ankle reduction done under sedation. Due to wound contamination fracture fixation was delayed, once the wound healed bi-malleolar fracture fixation was done.</p>

scholarly journals A rare injury to a rear seat passenger: bilateral fracture dislocation of the shoulders

2015 ◽  
Vol 2015 (jun11 1) ◽  
pp. bcr2015209992-bcr2015209992 ◽  
Author(s):  
S. Madi ◽  
V. Pandey ◽  
K. Acharya ◽  
K. P. Peruvaje Ramakrishna
Keyword(s):  
Rear Seat ◽  
Fracture Dislocation ◽  
Rare Injury ◽  
Bilateral Fracture

scholarly journals Delayed Peroneal Neuropathy After Bosworth Fracture Dislocation of the Ankle

2021 ◽  
Vol 111 (4) ◽  
Author(s):  
Sung Hoon Choi ◽  
Jeong Min Hur ◽  
Kyu-Tae Hwang
Keyword(s):  
Soft Tissue ◽  
Internal Fixation ◽  
Closed Reduction ◽  
Open Reduction ◽  
Fracture Dislocation ◽  
Tibial Tubercle ◽  
Proximal Fragment ◽  
Rare Injury ◽  
Soft Tissue Swelling ◽  
Severe Soft Tissue

The Bosworth ankle fracture-dislocation is a rare injury and is often irreducible because of an entrapped proximal fragment of the fibula behind the posterior tibial tubercle. Repeated closed reduction or delayed open reduction may result in several complications. Thus, early open reduction and internal fixation enable a better outcome by minimizing soft-tissue damage. We report on a 27-year-old man who underwent open reduction and internal fixation after multiple attempts at failed closed reduction, complicated by severe soft-tissue swelling, rhabdomyolysis, and delayed peroneal nerve palsy around the ankle.

scholarly journals Comparable behaviour of ring and little fingers due to an artificial reduction in thumb contribution to hold objects

2020 ◽  
Author(s):  
Banuvathy Rajakumar ◽  
Varadhan SKM
Keyword(s):  
Normal Force ◽  
Safety Margin ◽  
Ring Finger ◽  
Middle Finger ◽  
Human Hand ◽  
Mechanical Advantage ◽  
Free Condition ◽  
Normal Forces ◽  
Fixed Condition ◽  
Little Finger

AbstractBackgroundThe human hand plays a crucial role in accomplishing activities of daily living. The contribution of each finger in the human hand is remarkably unique in establishing object stabilization. According to the mechanical advantage hypothesis, the little finger tends to exert a greater normal force than the ring finger during a supination moment production task to stabilize the object. Similarly, during pronation, the index finger produces more normal force when compared with the middle finger. Hence, the central nervous system employs the peripheral fingers for torque generation to establish the equilibrium as they have a mechanical advantage of longer moment arms for normal force. In our study, we tested whether the mechanical advantage hypothesis is supported in a task in which the contribution of thumb was artificially reduced. We also computed the safety margin of the individual fingers and thumb.MethodologyFifteen participants used five-finger prismatic precision grip to hold a custom-built handle with a vertical railing on the thumb side. A slider platform was placed on the railing such that the thumb sensor could move either up or down. There were two experimental conditions. In the “Fixed” condition, the slider was mechanically fixed, and hence the thumb sensor could not move. In the “Free” condition, the slider platform on which the thumb sensor was placed could freely move. In both conditions, the instruction was to grasp and hold the handle (and the platform) in static equilibrium. We recorded tangential and normal forces of all the fingers.ResultsThe distribution of fingertip forces and moments changed depending on whether the thumb platform was movable (or not). In the free condition, the drop in the tangential force of thumb was counteracted by an increase in the normal force of the ring and little finger. Critically, the normal forces of the ring and little finger were statistically equivalent. The safety margin of the index and middle finger did not show a significant drop in the free condition when compared to fixed condition.ConclusionWe conclude that our results does not support the mechanical advantage hypothesis at least for the specific mechanical task considered in our study. In the free condition, the normal force of little finger was comparable to the normal force of the ring finger. Also, the safety margin of the thumb and ring finger increased to prevent slipping of the thumb platform and to maintain the handle in static equilibrium during the free condition. However, the rise in the safety margin of the ring finger was not compensated by a drop in the safety margin of the index and middle finger.

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