A Rare Case of Multiple Traumatic Volar Carpo-Metacarpal Joint Dislocations of the Hand

Abstract

Introduction: Fracture dislocations of the carpo-metacarpal joints are high energy injuries which may occur with or without fracture. Carpo-metacarpal fracture dislocations of the hand are uncommon injuries accounting for less than 1% of hand injuries. Case report: We report a 55 year old man presented who to the emergency room, with history of self-fall following which his left hand was run over by a bullock cart. Clinical examination of his hand revealed an abrasion 3x4 cm over the dorsum of his third metacarpal. There was diffuse swelling and tenderness over the dorsum of his hand. Radiographs showed that there was radial and volar dislocations of the second, third and fourth carpometacarpal joints with fracture of the trapezium, trapezoid and and chip fracture of the proximal phalynx of the thumb. Computerised topography of the hand revealed that there was also chip fracture of the hamate, chip fracture of the base of the fifth metacarpal in addition to the above mentioned injuries. The patient was surgically managed by open reduction and K-wire fixation. Conclusion: Volar carpo-metacarpal joint dislocations are unique in their presentation. They are serious injuries and need to be reduced at the earliest. The articulation of third metacarpal and capitate is more proximal than the carpal articulations of other CMC joints. This produces a keystone relationship with other CMC joints. When these injuries are detected early, closed reduction can be easily performed. If reduction fails, surgical reduction is mandatory. The disability of the hand is more severe if treatment is delayed.