Proposal for a Radiological Classification System for Carpo-Metacarpal Joint Dislocations with or without Fractures

ABSTRACT

@#Metacarpal (CMC) Joint dislocations represent only 1% ofall hand injuries, they have disabling impact on thefunctional status of patient. There are no reports in theliterature classifying disabling complex injuries like CMCjoint dislocations presumably because of low incidence. Wepropose a new classification through retrospective analysisof patients, along with literature search.Materials and Methods:A new classification system hasbeen proposed and designed at our clinical unit and appliedto eight patients with CMC joint dislocations. All patientswere treated with open reduction with Kirschner wirefixation. At follow-up all these patients were analysed forradiographic assessments and functional scores. Results: The proposed classification identifies three typesof dislocations and an additional complex category tosupplement any basic type. The direction of dislocationdescribes the types as Type A Dorsal, Type B Volar andType C Divergent. Among the eight patients in our study, wehad two of Type A, two Type B, three Type B.1, one TypeC.1. These patients had average follow-up of 18 months. Thequick DASH score improved from 75.76 at 6 weeks to 1.9 at18 months. We also did intra-observer and inter-observerreliability which scored 1.Conclusion:Our proposal is a reproducible, simple,comprehensive and practical classification, easilyremembered and communicated among colleagues. It isclinically relevant as it helps us in planning surgicalmanagement and prognostic evaluation.