Simultaneous fracture/dislocation of the thumb carpometacarpal (CMC) joint and dislocation of the metacarpophalangeal (MCP) joint is considered as a rare injury pattern. We report an unusual case of dorsal dislocation of MCP joint of the thumb associated with extraarticular fracture of the base of the first metacarpal in a 28-year-old man. The dislocation of MCP joint had been missed during initial presentation at a peripheral centre. The patient made an uneventful recovery following open reduction and fixation with 1.25 mm Kirschner wire of the MCP joint along with repair of the ulnar collateral ligament. This injury pattern has not been previously reported to the best of our knowledge in the English-language based medical literature.
Accidental Falls ; Adult ; Bone Wires ; Diagnostic Imaging ; Fractures, Bone ; diagnosis ; surgery ; Humans ; Joint Dislocations ; diagnosis ; surgery ; Male ; Metacarpophalangeal Joint ; injuries ; surgery ; Orthopedic Procedures ; methods ; Thumb ; injuries ; surgery

PURPOSECerclage wire application has emerged as a potential therapeutic adjunct to intramedullary nailing for subtrochanteric fractures. But its popularity is plagued by the concern of possible negative effect on fracture zone biology. This study was intended to analyze the clinico-radiological outcome and complications associated with cerclage wire application.

METHODSRetrospective analysis was performed on all the subtrochanteric fractures operated with intramedullary nailing between January 2012 and January 2016. After exclusion, 48 patients were available with an average follow-up of 20.8 months. Long oblique, spiral, spiral wedge or comminuted fracture configurations with butterfly fragments were particularly considered for cerclage wire application, which was employed by percutaneous cerclage passer in 21 patients. Assessment was done in terms of operation time, blood loss, quality of reduction, neck-shaft angle, follow-up redisplacement, union time, complications, and final functional evaluation by Merle d'Aubigne'-Postel score.

RESULTSAverage operation time and blood loss were significantly higher in cerclage group (p < 0.05). However, cerclage use substantially improved quality of reduction in terms of maximum cortical displacement (p = 0.003) and fracture angulation (p = 0.045); anatomical reduction was achieved in 95.23% of cases as compared to 74.07% without cerclage. Union time was shorter, although not statistically different (p = 0.208), in cerclage group. Four patients in non-cerclage group developed non-union, 2 of them had nail breakage. No infection or any other implant related complications were reported with cerclage use.

CONCLUSIONMinimally-invasive cerclage wire application has proved to be beneficial for anatomical reconstruction in difficult subtrochanteric fractures, whenever applicable, without any harmful effect on fracture biology.