Factors influencing the need for open reduction in ulnar-sided carpometacarpal joint fracture-dislocation: A retrospective cohort study.

BACKGROUND

Ulnar-side carpometacarpal joint (CMCJ) fracture-dislocation is a rare hand injury, accounting for <1% of all hand and wrist injuries, and is often overlooked on plain radiographs. Surgical treatment is usually required, but the optimal approach depends on the fracture pattern and timing of diagnosis. The aim of this study is to explore the factors that make open reduction necessary for proper fracture alignment and to evaluate patient recovery after such procedures.

METHODS

This study retrospectively reviewed patients who underwent surgical treatment for ulnar-side CMCJ fracture-dislocation between 2009 and 2022. Data on demographics, injury mechanism, time from injury to surgery, and surgical techniques were recorded. Postoperative outcomes were assessed using functional scores, including the Mayo Wrist Score (MWS), Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH), the Visual Analogue Scale (VAS), and radiographic evaluations.

RESULTS

A total of 44 patients (median age 36.4 years; 34 men and 10 women) were included. The median time from injury to surgery was 7 days (range, 1 to 61 days). Open reduction was required in all 17 patients with delayed surgery (≥2 weeks; p < 0.01). Among the 13 patients in the acute group who required open reduction, 11 patients presented with impacted type or intra-articular comminution fractures ( p = 0.04). Anatomic reduction was achieved in 42 of 44 patients (95.2%), who demonstrated favorable outcomes with high functional scores, minimal pain, and absence of radiographic evidence of post-traumatic arthritis during follow-up.

CONCLUSION

Surgical delay and fracture pattern are key determinants for the need for open reduction. Early recognition and timely surgical management are crucial in the treatment of ulnar-side CMCJ fracture-dislocations. Even in delayed cases, restoring alignment and joint stability can still yield good functional outcomes and reduce the risk of long-term complications.