TRAUMATIC DISLOCATION OF THE THUMB CARPOMETACARPAL JOINT EARLY LIGAMENTOUS RECONSTRUCTION VERSUS CLOSED REDUCTION AND PINNING

Early reconstruction of the thumb carpometacarpal (CMC) joint after tr aumatic dislocation, when instability is present, may decrease the inc idence of recurrent instability and post-traumatic joint degeneration. We report two retrospective cohort groups of patients who had sustain ed a traumatic thumb CMC joint dislocation. The first 8 patients, grou p A, were treated with closed reduction and pinning. Because the resul ts were unsatisfactory with 4 patients, requiring revision surgery for recurrent instability in 3 and degenerative arthritis in 1, the treat ment plan was changed to open reduction with a flexor carpi radialis w eave, group B. The 9 patients in group B underwent early (an average o f 7 days after injury) ligamentous reconstruction to decrease the inci dence of joint damage from recurrent instability and improve long-term functional results. For patients in group B with a minimum follow-up period of 2 years, pain was not a major problem, and range of motion a nd grip strength were essentially preserved. The functional variables affected most in both groups were thumb abduction, which was decreased by 10%, and pinch strength, which was decreased by 13%, in group B, a s compared to 20% and 19%, respectively, for the patients in group A. Radiographically, the joint space was slightly narrowed (Eaten stage I I) in 3 cases in group B; however, these were asymptomatic. In group A , 5 patients demonstrated degenerative changes of the CMC joint (3 Eat en stage II, 2 stage III), and 3 patients were symptomatic after treat ment.