Carpometacarpal Dislocation Research Articles

Plate Fixation of Hamate Fractures in Fourth and Fifth Carpometacarpal Fracture Dislocations.

Traumatic dislocations of the fourth and fifth metacarpals, in conjunction with dorsal hamate fractures, are a common entity that can lead to the instability of the fourth and fifth carpometacarpal (CMC) joints. The fracture of the hamate, usually in a coronal dorsal shear configuration, can lead to the dorsal subluxation of the hamatometacarpal joint. Open reduction and internal fixation of the hamate bone with a dorsally applied buttress plate can re-establish a stable and congruent joint surface and anatomically align the articular surfaces of the small and ring finger CMC joints. We present a technique of internal fixation of the hamate to facilitate the reduction of the hamatometacarpal joints. Using a dorsal approach centered over the fourth and fifth CMC joints, the joint surfaces are directly visualized and subsequent fixation of the hamate is performed using a 1.3-mm T-plate to securely buttress its articular surface. This technique presents an approach to the multifaceted injury pattern of fourth and fifth CMC dislocations associated with a hamate fracture.

Carpometacarpal Dislocations of the 2nd to 5 th Ray Associated with Multiple Other Injuries in a High Energy, Motor Vehicle Accident. A Case Report

Carpometacarpal Dislocations of the 2nd to 5 th Ray Associated with Multiple Other Injuries in a High Energy, Motor Vehicle Accident. A Case Report

Comparison of mini-plate versus Kirschner wire internal fixation for fifth metacarpal basal fractures with carpometacarpal joint dislocation.

To compare the outcome of mini-plate versus Kirschner wire (K-wire) internal fixation for treating fifth metacarpal basal fractures with carpometacarpal joint dislocation. A total of 46 patients with fifth metacarpal basal fractures combined with carpometacarpal joint dislocation were divided into two groups. The control group received K-wire fixation, while the observation group underwent mini-plate fixation. We assessed treatment effectiveness, surgical parameters, range of motion, serum stress markers, quality of life scores, and postoperative complication rates. A multivariable logistic regression analysis was performed to identify factors influencing postoperative joint function. The observation group demonstrated a significantly higher excellent and good rate compared to the control group (P<0.05). Additionally, the observation group had a lower intraoperative bleeding volume, shorter incision lengths, and faster fracture healing times, all significant differences (all P<0.05). Postoperative assessments indicated that range of motion, quality of life scores, and superoxide dismutase levels were significantly improved in the observation group (P<0.05). Conversely, cortisol, angiotensin II, and norepinephrine levels, along with the incidence of postoperative complications, were lower in the observation group compared to the control group (all P<0.05). Logistic regression analysis identified the surgical method as an independent factor affecting postoperative metacarpal joint function (OR = 0.16, P = 0.003). Mini-plate internal fixation is superior to K-wire fixation for the treatment of fifth metacarpal basal fractures with carpometacarpal joint dislocation. It promotes faster fracture healing, reduces serum stress markers, enhances joint mobility and quality of life, and decreases postoperative complications.

Volar radial Carpometacarpal dislocation of the fourth and fifth fingers

Carpometacarpal ligaments converge at the base of the metacarpal. Only very violent trauma can cause carpometacarpal dislocation. We report the case of a 23-year-old patient admitted for volar dislocation of the 4th and 5th finger with radial displacement. We did proceed to a closed reduction maintained by a splint the evolution was satisfactory with the recuperation of grip force. The mechanism of the injury can be direct or indirect. The displacement can suggest is there or not a complete rupture of the carpometacarpal ligaments. After closed reduction, the treatment can be surgical (which is preferred) with k-wire fixation or nonsurgical with splint immobilization with a close follow-up to avoid the loss of the reduction.

Do Computerized Tomography Scans Change Management in Carpometacarpal Dislocations and Fracture-Dislocations?

Concomitant carpal injuries with dislocations and fracture-dislocations of the carpometacarpal joints (CMCD/FD) are often hard to see on plain radiographs, making advanced imaging a useful diagnostic adjunct. We aim to: (1) characterize bony injury patterns with CMCD/FD; and (2) determine the frequency that preoperative computed tomography (CT) scans change surgical management. A retrospective review was performed of patients who underwent operative fixation of CMCD/FD from 2006 to 2021. X-ray and CT scan diagnoses were reviewed and correlated to intraoperative findings and procedures performed. Statistical analyses were performed to evaluate the frequency in which CT scans changed management and the frequency of new intraoperative diagnoses. Seventy-five patients were identified. All patients had a preoperative x-ray, and 27 patients (36%) additionally had a CT scan. Patients who sustained high-velocity trauma were significantly more likely to obtain a CT scan than patients with low-velocity trauma (P = .019); however, the number of additional diagnoses was not significantly associated with trauma velocity (P = .35). Computed tomography scans significantly increased the number of diagnoses (P < .001) and changed operative management in 58% of cases. Six of the 48 patients (12.5%) that did not receive a CT scan had new intraoperative diagnoses, which changed the procedure for five of these patients. New intraoperative diagnoses were identified significantly more when patients did not have a CT scan (P = .04). Obtaining a CT scan in CMCD/FD patients changed the patient's diagnosis at a significant rate and changed operative management roughly half of the time. The authors recommend routine CT scans be obtained in patients with CMCD/FD.

Carpometacarpal dislocation second to fifth with associated hamate fracture: A case report of rare injury

Carpometacarpal (CMC) dislocation of the second to fifth metacarpals is an extremely rare hand injury that results from high-energy trauma. It is inherently unstable, especially if it is associated with concomitant carpal or metacarpal fractures.We report the case of an 18-year-old male who sustained a motorbike injury at the level of the second to fifth CMC joints, which was associated with a hamate fracture. The patient failed initial conservative treatment, and so one week later he underwent closed reduction of the second to fifth carpometacarpal dislocations and Kirschner wire fixations from the second to fifth metacarpals. He then underwent open reduction and internal fixation of the hamate fracture using a mini-fragment plate and screws.This type of hand trauma is often overlooked due to radiological misinterpretations. It is important to pay attention to significant soft tissue swelling in this injury. Percutaneous pinning is still considered the gold standard and safest procedure for this injury.This is a rare hand injury that requires careful radiological assessment and meticulous and stable reduction. We believe that open reduction is advantageous in certain circumstances.

Carpometacarpal subluxation and dislocation following first metacarpal distraction osteogenesis

Carpometacarpal subluxation and dislocation following first metacarpal distraction osteogenesis

Bennett fracture combined with hamate fracture: carpometacarpal joint ‘diagonal’ fracture and dislocation: a case report

BackgroundMultiple carpometacarpal fractures and dislocations are rare. This case report describes a novel multiple carpometacarpal injury, namely, ‘diagonal’ carpometacarpal joint fracture and dislocation.Case presentationA 39-year-old male general worker sustained a compression injury to his right hand in the dorsiflexion position. Radiography indicated a Bennett fracture, hamate fracture, and fracture at the base of the second metacarpal. Subsequent computed tomography and intraoperative examination confirmed an injury to the first to fourth carpometacarpal joint along a diagonal line. The normal anatomy of the patient’s hand was successfully restored via open reduction combined with Kirschner wire and steel plate fixation.ConclusionOur findings highlight the importance of taking the injury mechanism into account to avoid a missed diagnosis and to choose the best treatment approach. This is the first case of ‘diagonal’ carpometacarpal joint fracture and dislocation to be reported in the literature.

Carpo-Metacarpal Joint Dislocation of the Thumb-Conservative Treatment

Introduction: Isolated thumb carpometacarpal joint dislocation is a rare lesion that accounts for less than 1% of all hand injures. We present traumatic isolated thumb carpometacarpal joint dislocation case. Patient treated conservative by closed treatment under local anesthesia, he had a good functional outcome and showed no signs of thumb carpometacarpal instability or arthritis. Isolated thumb carpometacarpal dislocation is a rare lesion that can cause joint instability or arthritis, which interferes with the normal function of the hand and can lead to articular degenerative changes. The best management of this lesion is still controversial, since there is lack of evidence in the literature showing superiority of one treatment over the other.

Carpo metacarpal dislocation of the 4th and 5th finger

Carpo metacarpal dislocation of the 4th and 5th finger

Anatomic and Biomechanical Study of Thumb Carpometacarpal Dislocations: A Laboratory Study.

No previous study recreating an isolated thumb carpometacarpal (CMC) dislocation with or without suture augmentation has been performed in the laboratory. This investigation aimed to evaluate the mechanism and ligamentous complex of isolated thumb CMC dislocations. Biomechanical analysis was performed in 10 cadaveric specimens. A posteriorly directed force or axial loading with hyperflexion through the CMC joint was applied. Load was applied at a rate of 1 mm/s until posterior CMC dislocation was achieved. Maximum load, displacement under nominal loading, stiffness, and mode of failure were recorded. The native ligament was repaired, augmented with high-tensile suture, and testing was repeated. Posteriorly directed force produced posterior CMC dislocations, while axial loading and hyperflexion through the CMC joint caused fractures. Load-to-failure of the native CMC joint was 217.76 N (SD = 66.03). Stiffness of the ligamentous complex on average was 18.86 N/mm (SD = 8.83). Mean load-to-failure after repair with suture augmentation was 94.62 N (SD = 39.77), with average stiffness of 8.21 N/mm (SD = 3.06). The native ligament was noted to have greater stiffness (P = .002) and greater load-to-failure (P = .0001) than repair with suture augmentation. Maximum displacement-to-failure of the native ligament was 14.5 mm compared with repair with suture augmentation 11.9 mm (P = .068). Isolated CMC dislocation was achieved with a posteriorly directed force rather than hyperflexion of the joint. Ultimate failure load of the repaired ligaments with suture augmentation was about half of that of the native ligaments. Further research into this technique is warranted.

Thumb metacarpal dislocation after trapeziectomy with ligamentous reconstruction and tendon interposition: A case report

Thumb carpometacarpal (CMC) arthritis is one of the most common and debilitating pathologies evaluated by the hand surgeon, affecting up to 35% of individuals over 55 years of age. Though multifactorial in etiology, dorsal and radial subluxation of the thumb CMC due to incompetency of the volar beak ligament is thought to be among the most important factors contribution to the arthritis. Multiple operative interventions have been proposed to best address this pathology. In the United States, trapeziectomy with ligament reconstruction and tendon interposition (LRTI) as described by Burton and Pellegrini remains the most widely used technique. As an isolated trauma, dislocation of the thumb CMC joint is a rare injury, only comprising approximately 1% of injuries evaluated by hand surgeons. Typically, thumb CMC dislocations occur due to axial load with the thumb in a flexed position. They are most commonly dorsal dislocations, and are thought to occur due to failure of the dorsoradial ligament. To date, no cases of CMC dislocation after LRTI have yet been described in the literature. Here we present a patient with volar thumb CMC dislocation as a rare complication after LRTI. After percutaneous pinning and immobilization followed by hand therapy, the patient has had a successful return to work with improved pain, restored function, and no further instability.

Functional Results of the Management of Carpometacarpal Dislocations of the Long Fingers: A Series of 11 Cases

Dislocations of the carpometacarpal joint of the fingers are infrequent, accounting for less than 1% of all injuries of the hand. We reported the functional results of 11 cases of CMC dislocations, presented the epidemiological, clinical and management characteristics of these lesions.

Thumb Carpometacarpal joint dislocation: Case report and short review

Thumb carpometacarpal (CMC) joint dislocation is rare, and the treatment options may vary from conservatives’ strategies to open reduction and fixation. In face of pain and joint instability persistence, surgical intervention is required. We present the case of a 67-year-old male that was referred to our hospital with pain and edema of the left hand, after the failure of a conservative treatment. After initial refusal of open surgery, due to the persistent joint instability, open reduction of the CMC joint dislocation was performed, and stabilized using two percutaneous Kirschner wires after repairing the joint capsule and dorsoradial ligament. Immobilization was required for 4 weeks. After that, the Kirschner wires were removed. Along with physiotherapy, the follow-up showed no pain persistence nor CMC joint luxation reoccurrence while the joint recovered its mobility. Further studies are required in order to determine the optimal therapy for such cases and to provide standardized recommendations, taking into account that the restoration of thumb CMC joint mobility is one of the most important goals in hand surgery.

Complete Dorsal Carpo-Metacarpal Spatular Dislocation: A Case Report

Carpo-metacarpal dislocations are rare traumatic injuries resulting from violent trauma; they are mostly observed in young subjects. The spatular form is often accompanied by metacarpal fractures. We report a clinical case of complete dorsal carpo-metacarpal spatular dislocation. This was a 34-year-old patient, admitted for a closed trauma of the right hand, in whom the clinical examination noted edema of the hand. The radiological workup showed a complete dorsal spatular dislocation associated with a fracture of the base of the 2nd metacarpal. The reduction of these lesions in closed focus followed by stabilization by metacarpal broaching associated with an intermetacarpal transverse broach was done under scopic control in emergency. Functional rehabilitation was started in the 3rd week. The broaches were ablated at the 6th week. The functional result at 3 months was satisfying with good muscle strength. Resumption of work was effective at 8 weeks. Carpo-metacarpal dislocations are rare injuries, often unrecognized, especially in polytrauma patients, and have a good functional prognosis if they are managed correctly in an emergency.

Carpometacarpal Dislocation with Third Metacarpal Fracture.

Case PresentationA 17-year-old male presented to the emergency department (ED) due to trauma to the right hand and wrist after punching a locker at school. He had significant soft tissue swelling. Radiographs demonstrated intra-articular metacarpal fractures with associated carpometacarpal dislocations. The dislocation was reduced bedside in the ED and ultimately underwent closed reduction surgical management with orthopedic surgery.DiscussionMetacarpal fractures result from high-force impact injuries and account for 30–40% of all hand injuries. The most common sites of second through fifth metacarpal fractures are at the neck and the shaft, with the majority involving the fifth metacarpal neck (commonly coined “boxer’s fractures”). Carpometacarpal (CMC) dislocations are a rare injury associated with high-force impact trauma to the wrist. These injuries account for as little as 1% of all acute hand and wrist injuries.1,2 Carpometacarpal dislocations are often difficult to diagnose on physical examination due to significant soft tissue swelling, and they can easily be missed on anterior-posterior views of the hand. Lateral and oblique plain radiograph views are essential in the diagnosis as they are more likely to show dislocations. Despite appropriate plain radiographic views, subtle CMC dislocations may be difficult to discern dependent on the level of dislocation or subluxation and overlapping of joints. These injuries are rare due to otherwise highly stable ligamentous and muscular attachments within the wrist. Because of these attachments, dislocations are often associated with concomitant metacarpal fractures.3

Near-miss Injury of Multiple Carpometacarpal Joint Dislocations: A Report of Two Cases

Multiple carpometacarpal joint (CMCJ) dislocations are rare and are easily missed. The anatomical configuration renders stability to the joints. As a result, a high-velocity impact is required to dislocate the joint. We present two cases of multiple carpometacarpal joint dislocations with different mechanisms of injury and their subsequent management at our centre. In case 1, a 29-year-old gentleman presented with acute dislocations of the CMCJs involving the right middle, ring, and little fingers. An open reduction and fixation with Kirschner wires were done to stabilize the dislocated CMCJs and he subsequently recovered. In case 2, a 25-year-old gentleman had the CMCJ dislocations detected late due to other more profound injuries. Partial arthrodesis was performed to address the instability of the CMCJs of the right index, middle and ring fingers. He subsequently recovered and returned to work 6-months postoperatively. The diagnosis of carpometacarpal joint dislocation can be easily missed especially when there is a concurrent distracting injury. It is crucial to maintain a high index of suspicion as early diagnosis and prompt treatment is paramount to yield a better outcome.

Lesser carpometacarpal fracture dislocation complicated by a compartment syndrome: A case report

Lesser carpometacarpal fracture dislocation complicated by a compartment syndrome: A case report

Update to the difficulties in diagnostic and therapeutic management of the rare carpometacarpal joint II-V dislocation injuries: Case presentation and review of literature

Update to the difficulties in diagnostic and therapeutic management of the rare carpometacarpal joint II-V dislocation injuries: Case presentation and review of literature

Surgical Management of Ulnar Metacarpal Base Fracture-Dislocations: A Systematic Review.

Ulnar metacarpal base fractures can destabilize the carpometacarpal (CMC) joint, prompting surgical stabilization. Studies investigating this injury are limited by small case volumes. Our purpose is to review the surgical techniques, outcomes, and complications of ulnar CMC joint stabilization. A literature search was performed of all articles published on the surgical treatment and outcomes of ulnar CMC fracture dislocations using PubMed and Google Scholar databases between the years 2014 and 2019. Data were pooled and analyzed, assessing surgical techniques and hand outcome measures: union, recurrent dislocations, range of motion, grip strength, and complications. Six studies met inclusion criteria. All surgical patients, regardless of technique, went on to union with no incidents of recurrent instability. Grip strength was significantly decreased postoperatively (82.7% of uninjured side). Patients with CMC dislocations of both the fourth and fifth ray had similar postoperative outcomes to those with CMC dislocations of the fifth ray alone. One third of plate and screw constructs required plate removal, due to breakage (2) or implant-related pain (4). Plate-related symptoms resolved after removal in all cases. Delayed treatment decreased the effectiveness of nonoperative treatment, and increased the likelihood of postoperative pain, chronic deformity, malunion, and CMC osteoarthritis. Closed reduction percutaneous pinning, open reduction percutaneous pinning, and open reduction internal fixation with CMC joint bridging or dorsal buttress plating are all well described, safe techniques with low complication rates. Early, accurate diagnosis of fourth and fifth CMC joint fracture-dislocations is crucial for optimizing hand function and postoperative outcomes.