Open Reduction for Dorsal Dislocation of Second to Fifth Carpometacarpal Joints: A Case Report

Abstract

Background Fracture-dislocations of all four ulnar (second to fifth) carpometacarpal (CMC) joints are rare hand injuries and frequently overlooked or missed. These injuries can be treated conservatively when closed reduction is successfully achieved, though they are sometimes irreducible and unstable.

Case Description We report the case of a 17-year-old boy involved in a vehicular accident. Clinical images showed dorsal dislocation of all four ulnar CMC joints of the left hand associated with a fracture of the base of the fourth metacarpal. Although closed reduction was attempted immediately, the affected joints remained unstable and easily redislocated. Therefore, we performed open reduction and percutaneous fixation of all ulnar CMCs. He showed excellent recovery after 1 year postoperatively, reported no pain, and demonstrated complete grip strength and range of motion of the affected wrist and fingers.

Literature Review Accurate clinical diagnosis of this lesion is difficult because of polytrauma, severe swelling masking the dislocated CMC joint deformity, and overlapping of adjacent metacarpals and carpal bones on radiographic examination. As for the treatment strategy, it has yet to obtain a consensus. Some reports value open reduction to guarantee anatomical reduction, and it is definitely needed in the patients with interposed tissues to be removed or with subacute and chronic injuries.

Clinical Relevance Delayed diagnosis or treatment could lead to poor outcomes. Therefore, surgeons must be aware that precise preoperative assessment is critical, and anatomical open reduction of interposed bony fragments, like our case, may be required even in an acute phase.

Keywords

carpometacarpal joints - fracture-dislocation - open reduction - overlook injury

Ethical Approval

Informed consent was obtained from the patient and his parents for publication.

Publikationsverlauf

Eingereicht: 14. Mai 2020

Angenommen: 06. Juli 2020

Artikel online veröffentlicht:
27. August 2020

• References

• 1 Siddiqui YS, Zahid M, Sabir AB. et al. Multiple carpometacarpal fracture dislocation of the hand: an uncommon pattern of injury which is often missed: a case report with review of literature. J ClinDiagn Res 2011; 5 (03) 618-620
• 2 Henderson JJ, Arafa MA. Carpometacarpal dislocation. An easily missed diagnosis. J Bone Joint Surg Br 1987; 69 (02) 212-214
• 3 Kjaer-Petersen K, Jurik AG, Petersen LK. Intra-articular fractures at the base of the fifth metacarpal. A clinical and radiographical study of 64 cases. J Hand SurgBr 1992; 17 (02) 144-147
• 4 Steinmetz G, Corning E, Hulse T. et al. Carpometacarpal fracture-dislocations: a retrospective review of injury characteristics and radiographic outcomes. Hand (N Y) 2019; 11: 1558944719852743
• 5 Zhang C, Wang H, Liang C. et al. The effect of timing on the treatment and outcome of combined fourth and fifth carpometacarpal fracture dislocations. J Hand Surg Am 2015; 40 (11) 2169-2175.e1
• 6 Lawlis III JF, Gunther SF. Carpometacarpal dislocations. Long-term follow-up. J Bone Joint Surg Am 1991; 73 (01) 52-59
• 7 Hunt III TR. Degenerative and post-traumatic arthritis affecting the carpometacarpal joints of the fingers. Hand Clin 2006; 22 (02) 221-228
• 8 Prokuski LJ, Eglseder Jr WA. Concurrent dorsal dislocations and fracture-dislocations of the index, long, ring, and small (second to fifth) carpometacarpal joints. J Orthop Trauma 2001; 15 (08) 549-554
• 9 Yoshida R, Shah MA, Patterson RM, Buford Jr WL, Knighten J, Viegas SF. Anatomy and pathomechanics of ring and small finger carpometacarpal joint injuries. J Hand Surg Am 2003; 28 (06) 1035-1043
• 10 Moriya K, Saito H, Takahashi Y, Ohi H. Divergent fracture-dislocation of the hamatometacarpal joint: case report. J Hand Surg Am 2011; 36 (01) 47-51
• 11 Gehrmann SV, Grassmann JP, Schneppendahl J. et al. Treatment strategy for carpometacarpal fracture dislocation [in German]. Unfallchirurg 2011; 114 (07) 559-564
• 12 Hani R, Jeddi I, Berrada MS. Divergent dislocation of the carpometacarpal joints: a case report. J Med Case Reports 2018; 12 (01) 157
• 13 Storken G, Bogie R, Jansen EJP. Acute ulnar carpometacarpal dislocations. Can it be treated conservatively? A review of four cases. Hand (N Y) 2011; 6 (04) 420-423
• 14 Saing MH, Lee SY, Raphael JS. Percutaneous pinning of fifth carpal-metacarpal fracture-dislocations: an alternative pin trajectory. Hand (N Y) 2008; 3 (03) 251-256
• 15 Austin NM. The wrist and hand complex. In: Levangie PK, Norkin CC. eds. Joint Structure and Function: A Comprehensive Analysis. 5th ed. Philadelphia, PA: Davis; 2011: 305-353
• 16 El-Shennawy M, Nakamura K, Patterson RM, Viegas SF. Three-dimensional kinematic analysis of the second through fifth carpometacarpal joints. J Hand Surg Am 2001; 26 (06) 1030-1035
• 17 Pundkare GT, Patil AM. Carpometacarpal joint fracture dislocation of second to fifth finger. ClinOrthopSurg 2015; 7 (04) 430-435
• 18 Peace WJ, Abrams RA. Simultaneous dorsal dislocations of the carpometacarpal joints of all four fingers. Orthopedics 2010; 33 (02) 121-123
• 19 Sharma AK, John JT. Unusual case of carpometacarpal dislocation of all the four fingers of ulnar side of hand. Med J Armed Forces India 2005; 61 (02) 188-189