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

Javed Jameel,Mohd Zahid,Mazhar Abbas,Abdul Qayyum Khan

doi:10.1007/s10195-012-0181-3

Javed Jameel, Mohd Zahid + Show 2 more

Open Access

https://doi.org/10.1007/s10195-012-0181-3

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Abstract

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.

Highlights

Volar carpometacarpal dislocations of the fingers of the ulnar side of the hand are a relatively uncommon injury [1, 2], but those involving the middle three metacarpals are rarer still
Volar carpometacarpal dislocation is a rare form of hand injury that can be missed without applying a high level of suspicion and performing a meticulous examination
We present a rare case of compound volar dislocation of the second, third, and fourth carpometacarpal joints in a 40-year-old male

Summary

Introduction

Volar carpometacarpal dislocations of the fingers of the ulnar side of the hand are a relatively uncommon injury [1, 2], but those involving the middle three metacarpals are rarer still Diagnosis of this unusual form of injury requires a high level of suspicion, careful examination, and good radiography. Examination of the right hand revealed swelling of the hand with a deep laceration (*6 cm) over the thenar eminence (Fig. 1a), diffuse tenderness over the carpometacarpal area, a palpable mass in the palm over the laceration at the ulnar margin of the thenar eminence, and a palpable depression (Fig. 1b) on the dorsum of the hand at the carpometacarpal junction His distal neurovascular status was intact, but the patient had restricted finger movement because of pain. Roentgenograms of the hand showed volar and radial dislocation of the second, third, and fourth carpometacarpal joints (Fig. 2a, b, and c)

Surgical procedure

Discussion