Volar dislocation of second, third, and fourth carpometacarpal joints: a rare and easily missed diagnosis

Volar carpometacarpal dislocation is a rare form of hand injury that can be easily missed without applying a high level of suspicion and performing a meticulous examination. In this case report, we present a rare case of compound volar dislocation of the second, third, and fourth carpometacarpal joints in a 40-year-old male. This was managed by closed reduction and the use of a mini external fixator. The patient regained a good range of motion in 6 weeks with no pain. It is important to diagnose and treat this injury in order to avoid the considerable morbidity associated with this condition.     

Divergent dislocation of the carpometacarpal joints: a case report

A motorcyclist presented for treatment with divergent dislocation of the bases of the four medial metacarpals, avulsion of the hook of the hamate, dislocation of the trapezium from the scaphoid, and palmar fracture-dislocation of the wrist. This constellation of injuries has never been described. The carpometacarpal joints were reduced at surgery and pinned. The patient is doing well 8 years later despite nonunion of the hook of the hamate.     

Simultaneous dislocation of the five carpometacarpal joints

Two new cases are added to the literature on four previously reported cases of simultaneous dislocation of the five carpometacarpal joints. The priorities of management of other more extensive injuries often delays definitive treatment and in the two cases reported here open reduction and internal fixation was necessary to restore the functional structure of the hand. Restoration of normal grip and pinch strength was obtained in both patients with stable, pain-free carpometacarpal joints.     

Isolated dislocation of the four ulnar carpometacarpal joints

Dislocation of the multiple carpometacarpal joints without associated fractures of the metacarpal and/or carpal bones is an exceedingly rare injury. An earlier belief that carpometacarpal dislocations are high-energy injuries is questioned due to an unusual case of isolated dislocation of the four ulnar metacarpals that occurred after a relatively minor hand trauma. Early recognition and anatomical reduction are essential to achieving good long-term outcomes. Massive edema, interposed volar ligaments and overlapping metacarpal bases are the usual obstacles to a successful closed reduction.     

Anterior dislocation of the second and third carpometacarpal joints

Anterior dislocations of the second and third carpometacarpal joints are extremely rare. The authors report a case of an anterior dislocation of the bases of the second and third metacarpals of the right hand treated by closed reduction and percutaneous wiring. The result was excellent and the authors think that this type of carpometacarpal dislocation does not need open reduction.     

Fracture dislocations of the carpometacarpal joints of the fingers

ObjectiveFracture dislocations of the multiple carpometacarpal joints [CMCJ] of the fingers are uncommon injuries that can significantly compromise hand function and durability if managed sub-optimally. These injuries are at risk of being missed as they are commonly a part of major high energy trauma with associated more obvious and immediately threatening injuries getting all the attention. The clinical and radiological parameters which could help a surgeon to detect and analyse these injuries well are discussed. The management of these injuries with emphasis on the pattern of K-wire fixation is presented.MethodA review of multiple CMCJ dislocations at our institution found 39 hands in 38 patients (one case with bilateral injury) over a seven-year period (January 2010 to January 2017). The pattern of injury noted in these cases was assessed and categorized. Our preferred management plan for these injuries is discussed.ResultsThe patterns of dislocations noted in a total of 39 cases were-dorsal (25), dorsal radial (6), volar (1), volar radial (5) and divergent (2). The dorsal dislocations were the commonest (25/39) and additional 6/39 were radial-dorsal, only six displaced in a volar direction. Divergent dislocation was seen in only two cases.ConclusionThe pattern of dislocations noted in 39 cases in our institute (Ganga Hospital- A tertiary level trauma center) is presented to provide an overview of the spectrum of the injuries which a surgeon could face. Early surgery is recommended and should be aimed to restore perfect anatomical alignment of the skeleton. Surgeon should have a low threshold for open reduction in case of gross swelling or inability to get an anatomical closed reduction. The method of K-wire fixation presented herein has resulted in good outcome in our practice; wherein we fix the dislocated CMCJ by inserting K-wires from the radial and ulnar borders of the hand and avoiding wires in the central part of the hand. This prevents extensor tendons tethering by the K-wires. The fixation achieved by multiple K-wires passed in this manner provides enough stability to allow for early active mobilisation of the fingers. The need for careful assessment to detect associated nerve injury and compartment syndrome; and post-operative strict hand elevation and prevention of stiffness of the MCP joints has been emphasized.The CMCJ dislocations have innumerable patterns possible; however, the management principles remain the same. In spite of the gross distortion of the anatomy seen in these injuries, anatomical reduction and adequate stabilization to allow early mobilization generally results in satisfactory outcomes.     

Simultaneous dorsal dislocation of the metacarpophalangeal and carpometacarpal joints of a finger

A case of simultaneous dorsal dislocation of the metacarpophalangeal (MP) and carpometacarpal (CMC) joints in the little finger is presented. The patient required a second surgical intervention for volar subluxation of the MP joint which occurred while wearing a dorsal splint following open reduction of the MP joint and closed reduction of the CMC joint. Two years postoperatively, the patient was asymptomatic but was left with mild stiffness of the MP joint.     

Floating thumb with double dislocation of carpometacarpal and metacarpo-phalangeal joints

INTRODUCTION

Double dislocations of carpometacarpal and metacarpo-phanlageal joints are rare. We report an unusual case of simultaneous dislocation of both CMC and MCP joints in the thumb.

PRESENTATION OF CASE

A 31 year old male was admitted following a road traffic accident. He was complaining of pain and deformity of right thumb. The X-ray examination revealed simultaneous dislocation of both CMC and MCP joints. He underwent closed manipulative reduction and percutaneous K wire fixation. The wires were removed after six weeks. After a course of physiotherapy he regained full range of pain free movements.

DISCUSSION

The incidence of simultaneous dislocation of both CMC and MCP joints in thumb are associated with high energy injuries. The options of treatment are conservative with cast immobilisation and serial X-rays or operative including closed manipulative reduction and K wire fixation or open reduction and internal fixation.

CONCLUSION

The option of treating this rare injury with closed manipulative reduction and percutaneous K wiring gives excellent and predictable results.     

Neglected fracture dislocation of the second and third carpometacarpal joints: a case report.

We report a rare case of neglected fracture dislocation of the second and third carpometacarpal joints, which was treated by arthrodesis of the involved joints.     

The carpometacarpal joints

Although less complex than the intercarpal joints, the carpometacarpal joints are very important to proper hand function, and their derangement can be very disabling. The anatomy and clinical problems of these joints are covered in this article.     

Multiple carpometacarpal volar dislocation

A case of multiple carpometacarpal joints volar dislocation in a young man of 25 years of age is reported. He presented with pain and deformity of his left hand immediately after road traffic accident. He was unable to move his left hand. X-rays of the affected hand showed volar dislocation of all four medial carpometacarpal joints. Dislocated joints were reduced, fixed with K-wires and immobilized in slab. K-wires were removed after 8 weeks. Hand function is satisfactory on the follow-up.     

Ulnopalmar dislocation of the fifth carpometacarpal joint. A rare injury

Volar dislocation of the carpometacarpal joint of the little finger is an uncommon injury. It is subdivided in ulnopalmar and radiopalmar dislocations. The injury can easily be missed on standard x-rays. Closed reduction and K-wire fixation has commonly been used in the treatment, although closed reduction and casting has been reported. Only 10 cases of an ulnopalmar dislocation were published previously. We report a case of a simultaneous dislocation of the 4th metacarpophalangeal joint and an ulnopalmar dislocation of the 5th carpometacarpal joint. The combination of these injuries has not been reported yet. We review the available literature and discuss the methods of treatment.     

Dorsal dislocation of the fourth and fifth carpometacarpal joints and simultaneous dislocation of the metacarpophalangeal joint of the small finger: a case report

A patient with dorsal dislocation of the fourth and fifth carpometacarpal (CMC) joints and dislocation of the metacarpophalangeal (MP) joint of the small finger was managed successfully by open reduction and transarticular fixation of the CMC joint dislocation and closed reduction of the MP joint dislocation. This rare combination of injuries has not been reported previously.     

Isolated carpometacarpal dislocation of the thumb: a case report

The traumatic fracture-dislocation of the first carpometacarpal joint is not frequent, isolated dislocation being even more uncommon. A twenty-five-year-old male patient was diagnosed as having carpometacarpal dislocation of the thumb by means of radiologic and physical examination findings. After immediate reduction, the thumb was immobilized in a short thumb spica cast for six weeks, after which he was enrolled into a rehabilitation program. No pain or instability were found at the end of six months.     

Fracture-dislocations of all five carpometacarpal joints: a case report

Injuries to all five carpometacarpal joints are rare. Only four cases have been reported in the English literature. A case of fracture-dislocations of all five carpometacarpal joints is presented. An excellent result has been obtained 2 years after open reduction and internal fixation. This case is the only one in the English literature so treated and with prolonged follow-up.