Ulnar paddlefish carpometacarpal dislocation of the three lesser fingers: a case report.

Lassaad Hassini,Mohamed Ali Khalifa,Thabet Mouelhi,Mohamed Laaziz Ben,Mourad Mtaoumi

doi:10.11604/pamj.2017.28.155.12517

Abstract

The long fingers’ paddlefish carpometacarpal (CMC) dislocation is exceptional. Most dislocations occur after high energy trauma. Untreated, these lesions can result in chronic instability of the CMC joints and early osteoarthritis. We report the case of a 20-year-old patient presenting with an ulnar paddlefish CMC fracture-dislocation of the three lesser fingers resulting from a hand trauma in the context of an occupational accident. Treatment is usually surgical though no strict consensus can be found upon literature review. If diagnosed early and no associated fractures are found, CMC dislocation could benefit from conservative treatment.

Highlights

Multiple dislocations of the carpometacarpal (CMD) are rare
The main etiology remains traffic accidents where massive fractures are often associated with the dislocation because of the high velocity of the trauma
Delayed treatment can result in neurovascular injuries due to oedema and prolonged compression. These lesions can result in chronic instability of the CMC joints and early articular degeneration

Summary

Introduction

Multiple dislocations of the carpometacarpal (CMD) are rare. The one involving the 2nd or 3rd metacarpal is poorly described in literature [1]. The main etiology remains traffic accidents where massive fractures are often associated with the dislocation because of the high velocity of the trauma. These injuries seriously compromise the functional prognosis. We report the case of a 20-year-old female patient with an ulnar paddlefish CMD of the three lesser fingers. A 20-year-old right-handed female factory worker with nomedical history is consulting in the emergency ward with an open trauma of the left hand resulting from an occupational accident. Her hand was crushed under a heavy object. At one year follow-up, the outcome is good (Figure 3): the patient is painless with good bone consolidation in right position, strictly normal range of motion (metacarpophalangeal 90°, proximal interphalagienne 100° and distal interphalageal 90°) and a 80% grip strength compared to the right side

Findings

Discussion

Conclusion