Transcarpal carpometacarpal dislocations, excluding the thumb.

During a 9-year period, we treated 13 patients with major fractures of bones of the distal carpal row creating instability of the corresponding carpometacarpal joints. Diagnosis of the injury was made early in only eight patients whose treatment consisted of open reduction, pin or screw fixation, and immobilization from 6 to 8 weeks. They showed no complications and had an excellent functional recovery. Diagnosis in five (38%) patients was delayed 1 week to 8 months after the accident. At initial presentation, symptoms included pain, loss of grip strength, and mild limitation of finger motion. In three patients an acute carpal tunnel syndrome developed a few days after the accident. Two had established nonunions of the capitate and the hamate. Treatment consisted of open reduction, bone grafting, fixation with multiple pins, and immobilization until fracture consolidation. Results in this group were good in one, moderate in three, and poor in one.