title: The Effect of Timing on the Treatment and Outcome of Combined Fourth and Fifth Carpometacarpal Fracture Dislocations.
abstract: OBJECTIVE
  In this study, we designed a prospective project to test the hypothesis that acute fourth and fifth carpometacarpal (CMC) fracture dislocations can be treated conservatively with good restoration of strength, range of motion (ROM), and function, whereas patients with delayed treatment of fourth and fifth CMC fracture dislocations should be treated with open reduction and internal fixation (ORIF).
  
  
  METHODS
  We evaluated the results of 20 patients with acute and 6 patients with subacute fourth and fifth CMC fracture dislocations. All 20 acute CMC fracture dislocations were treated conservatively, whereas 3 of the 6 patients with subacute injuries underwent operative intervention. The sensibility, ROM, and grip strength of the hands were tested during 1-year follow-up. The Michigan Hand Outcomes Questionnaire and control radiographs were also taken.
  
  
  RESULTS
  All 20 patients with acute CMC fracture dislocations showed good restoration of grip strength, ROM, and function, with an average Michigan Hand Outcomes Questionnaire score of 98 ± 2 at 1-year follow-up. Patients with delayed diagnosis who underwent conservative treatment had noticeable deformity of their injured hands, pain complaints, limited ROM at the fourth and fifth CMC joints, and decreased grip strength. The 3 patients with delayed diagnosis treated with ORIF showed good restoration of grip strength, ROM, and function.
  
  
  CONCLUSIONS
  Patients with acute CMC fracture dislocations can be treated by closed reduction with good restoration of grip strength, ROM, and function. In patients with delayed presentation of CMC fracture dislocations, we recommend ORIF.
  
  
  METHODS
  Therapeutic IV.
authors.affiliation: Department of Orthopaedic Surgery, Guangzhou Orthopedic Hospital, Guangzhou, China.
authors.forename: Chi
authors.initials: C
authors.lastname: Zhang
authors.affiliation: Department of Orthopaedics, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.
authors.forename: Hua
authors.initials: H
authors.lastname: Wang
authors.affiliation: Department of Orthopaedic Surgery, Guangzhou Orthopedic Hospital, Guangzhou, China.
authors.forename: Chizhang
authors.initials: C
authors.lastname: Liang
authors.affiliation: Department of Orthopaedic Surgery, Guangzhou Orthopedic Hospital, Guangzhou, China.
authors.forename: Weizhong
authors.initials: W
authors.lastname: Yu
authors.affiliation: Department of Orthopaedic Surgery, Guangzhou Orthopedic Hospital, Guangzhou, China.
authors.forename: Yunfeng
authors.initials: Y
authors.lastname: Li
authors.affiliation: Department of Orthopaedic Surgery, Guangzhou Orthopedic Hospital, Guangzhou, China.
authors.forename: Ruguo
authors.initials: R
authors.lastname: Shang
authors.affiliation: Department of Orthopaedic Surgery, Guangzhou Orthopedic Hospital, Guangzhou, China.
authors.forename: Chongbo
authors.initials: C
authors.lastname: Huang
authors.affiliation: Department of Orthopaedic Surgery, Guangzhou Orthopedic Hospital, Guangzhou, China. Electronic address: chongxiahuang@163.com.
authors.forename: Chongxia
authors.initials: C
authors.lastname: Huang
mesh_terms: D000293:Adolescent; D000328:Adult; D052737:Carpometacarpal Joints / Q000293:injuries* / Q000601:surgery; D002648:Child; D005260:Female; D005593:Fracture Fixation, Internal / Q000379:methods*; D050723:Fractures, Bone / Q000601:surgery / Q000628:therapy*; D018737:Hand Strength; D006801:Humans; D004204:Joint Dislocations / Q000601:surgery / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D016059:Range of Motion, Articular; D011795:Surveys and Questionnaires; D016896:Treatment Outcome
keywords: Carpometacarpal; ORIF; closed reduction; dislocations