The effect of ligament injury in the fifth carpometacarpal (CMC) joint on joint stabilization, comparison of different diagnosis and two treatment methods: cadaver study
Project no. 21992 · Status: Kapanmış (Yayın bekleniyor) · 2020
Summary
<p>The fifth carpometacarpal (5th CMC) joint injury is rare. The static stability of this joint is provided by four different ligament groups. Missed injury to this joint could negatively affect hand function. Diffrent X-ray viewing methods have been investigated. When 5. CMC injuries are left untreated or in cases of fragmented joint injuries, 5. CMC arthritis could be develop. Different arthrodesis methods have been developed for the treatment of 5. CMC joint arthritis.</p><p>The first aim of this study is to investigate the contribution of ligament stability. The second aim is to determine the sensitivity of oblique X-rays at 30°, 45°, and 60° of pronation. The third aim of the study is to compare two arthrodesis methods. This study executed on 17 cadaver hands. Four ligament groups were cut in different sequences, and intermetacarpal distance was measured using computed tomography. The 5. CMC joint was positioned in three different conditions (25% dislocation, 50% dislocation, and no dislocation), and three oblique X-rays were taken. Fifty-four X-rays were selected and evaluated in the form of a survey. This survey was evaluated by 7 orthopedic specialists and 13 orthopedic residents. The flexion and extension angles of the 5th metacarpal were measured before and after the application of the arthrodesis (5th metacarpal-hamate arthrodesis, 5th metacarpal-4th metacarpal arthrodesis). The 5. CMC joint did not dislocate without cutting the interosseous intermetacarpal ligaments. Minimal stability effects were found for dorsal and volar intermetacarpal and karpometacarpal ligament groups. In terms of sensitivity, the sensitivity of 30°, 45°, and 60° X-rays was found to be 31.05, 64.53, and 65.56, respectively. After applying the 5th metacarpal-hamate arthrodesis method and the 5th metacarpal-4th metacarpal arthrodesis method, the extension angle of the 5th metacarpal decreased significantly (p=0.046 and p=0.048, respectively). When the 5th metacarpal-hamate arthrodesis method was applied, the 5th metacarpal flexion angle remained unchanged (p=0.753), but when the 5th metacarpal-4th metacarpal arthrodesis method was applied, a significant decrease in the 5th metacarpal flexion angle was observed (p=0.028). In conclusion, the interosseous intermetacarpal ligament group is the main stabilizer. To detect 5. CMC injuries, it is recommended to take oblique X-rays at 45° and 60° from the pronation position. The 5th metacarpal-hamate arthrodesis method is recommended for 5. CMC joint arthrodesis treatment because it preserves the 5th metacarpal flexion angle.</p>