Isolated radial palmar dislocation of the fifth carpometacarpal joint with ulnar neuropathy associated: successful treatment with closed reduction and internal fixation

Carpometacarpal dislocations may be dorsal, volar or divergent type but most are dorsal with involvement of fourth and fifth metacarpal. Isolated volar dislocation of the fifth carpometacarpal joint is an uncommon injury specially when there is no associated fracture. We report a case of radial palmar dislocation of the base of fifth carpometacarpal joint associated to compression of the fourth interdigital nerve in the hand.     

The mechanism of dorsal fracture dislocation of the fifth carpometacarpal joint.

Fracture dislocation at the base of the fifth metacarpal is a rare injury. Fewer than 25 cases have been published in the English-language literature. A force acting along the longitudinal axis of the fifth metacarpal causes a fracture dislocation at the base of the bone in a dorsal-ulnar direction, because of the anatomy of the joint and the mechanical properties of the bone and the intermetacarpal ligament. The mechanism of other types of injury to this joint, namely dorsal-radial or palmar-radial dislocation of the base of the fifth metacarpal is different. A case is presented which demonstrates the mechanism of the fracture dislocation.     

Isolated palmar dislocation of the fifth carpometacarpal joint diagnosed by stress X-rays

Isolated palmar ulnar dislocation of the fifth carpometacarpal (CMC) joint is a rare injury which often yields only subtle radiographic findings that may be easily overlooked, especially when there is no associated fracture. We reported a case of an isolated palmar dislocation of the fifth CMC joint, diagnosed correctly by means of simple stress X-rays (traction and axial compression stress views). This method proved to be useful and needs no special equipment. Received: 7 January 1999     

Complex dorsal metacarpophalangeal joint dislocation caused by interosseous tendon entrapment: case report

We report a patient with open complex, dorsal metacarpophalangeal joint dislocation of the index finger with interposition of the first dorsal interosseous tendon and the transverse ligament of the palmar aponeurosis. To our knowledge, entrapment of the first dorsal interosseous tendon has not been reported to be the cause of irreducible dislocation of the metacarpophalangeal joint.     

Dorsal dislocation of the fifth carpometacarpal joint

A case of isolated dorsal dislocation of the fifth carpometacarpal joint treated conservatively is reported. The mechanism is thought to be a force hitting the head of the fifth metacarpal in a dorso-palmar direction, along the longitudinal axis of the metacarpal. Both clinical and radiological results 1 year after injury are satisfactory.     

Ulnar dislocation of fifth carpometacarpal joint.

Carpometacarpal dislocations may be dorsal, volar or divergent type but most are dorsal with involvement of 4th and 5th metacarpal. We are reporting first case of ulnar type of unilateral dislocation of 5th carpometacarpal joint.     

Complex dorsal dislocation of the second carpometacarpal joint

Isolated dislocation of the carpometacarpal joint of the index finger is a rare injury. This paper reports a case of an isolated dorsal dislocation of the second carpometacarpal joint not reducible by closed means. At open reduction, the extensor carpi radialis brevis was found to be interposed in the joint, blocking reduction.     

Ipsilateral mid-third clavicle fracture with grade V acromioclavicular joint dislocation

We report the case of a 20-year-old man with an ipsilateral mid-third clavicle fracture with grade V acromioclavicular joint (ACJ) dislocation. The combination of these two injuries is rare. A literature search produced various treatment algorithms. In this case, the patient was successfully treated with a Bosworth screw.This work was carried out in the Department of Orthopaedics, William Harvey Hospital, Ashford, Kent, UK     

Isolated dorsal dislocation of the tarsal naviculum

Isolated dislocation of the tarsal naviculum is an unusual injury, scarcely reported in the literature. The naviculum is surrounded by the rigid bony and ligamentous support hence fracture dislocation is more common than isolated dislocation. The mechanism and treatment options remain unclear. In this case report, we describe a 31 year old man who sustained an isolated dorsal dislocation of the left tarsal naviculum, without fracture, when he was involved in a motor vehicle collision. The reported mechanism of the dislocation is a hyper plantar flexion force applied to the midfoot, resulting in a transient disruption of the ligamentous support of the naviculum bone, with dorsal displacement of the bone. The patient was treated with open reduction and Krischner-wire fixation of the navicular after the failure of closed reduction. The wires were removed after 6 weeks postoperatively. Physiotherapy for stiffness and midfoot pain was recommended for 2 months. At 6 months postoperatively, limping, midfoot pain and weakness were reported, no X-ray abnormalities were found. The patient returned to his obvious activities with a normal range of motion.     

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.     

Isolated volar dislocation of the fifth carpometacarpal joint. Case report

A rare volar-ulnar dislocation of the base of the fifth metacarpal in a 73-year-old man was correctly diagnosed early and treated by closed reduction. The reduction was unstable and percutaneous skeletal fixation was applied to ensure stability. The functional results were excellent within four months of surgery.     

Isolated volar dislocation of the fifth carpometacarpal joint: a case report.

Isolated volar dislocation of the fifth carpometacarpal joint is a very rare injury. We present two cases of isolated volar dislocation of the fifth carpometacarpal joint treated successfully with percutaneous skeletal fixation.     

Unstable dorsal fractrue-dislocation of the fifth carpometacarpal jont

Four cases of unstable fracture-dislocation of the fifth carpometacarpal joint are reproted, including 3 isolated dorsal fracture-dislocation and 1 dorsal fracture-dislocation associated with a fracture of the fourth metacarpal bone. All cases required open reduction and Kirschner wire fixation which resulted in good function. Attention is drawn to the frequent delay in diagnosis. The applied anatomy is discussed.     

Isolated dorsal approach for the treatment of neglected volar metacarpophalangeal joint dislocations

Here, we present the clinical and radiological results of three neglected volar metacarpophalangeal dislocations in 2 patients, which were treated with open reductions 10 and 24 mo after the dislocations. There was a mean of a 20°(range 10°-30°) limitation of extension and a 53.3°(range 30°-70°) limitation of flexion preoperatively. Postoperatively, there was no limitation of extension(at 8 and 12 mo) in any of the fingers. In terms of flexion, one finger had full function, one had a 10° and the last one had a 30° limitation of flexion. Two of the fingers presented anesthesia preoperatively, which improved to hypesthesia postoperatively. One finger had hypesthesia, which improved postoperatively. During surgery, a ruptured dorsal capsule was found to have interposed into the joint, making closed reduction impossible. Our experience with these two patients demonstrated that, even in neglected cases, open reduction using an isolated dorsal approach may result in satisfactory clinical andradiological outcomes.