Carpometacarpal Dislocation Research Articles

Dislocations of all the carpometacarpal joints: A rare injury pattern

Orthopedic injuries can be misdiagnosed if physical examination is not feasible. The literature is abundant with different pattern of hand injuries. Carpometacarpal fracture dislocations constitute one of the rarest patterns of injuries of the hand. These injuries can often be missed because of the gross swelling and edema of the hand. The diagnosis of this unusual form of injury requires a high index of suspicion, vigilant examination and high-quality radiography. Apart from the routine antero-posterior and oblique radiographs, a lateral radiograph of the hand is essential for making an accurate diagnosis in suspected cases of carpometacarpal dislocations. Although many such case reports are described in the literature, we are reporting a rare case of dislocation involving all the five carpometacarpal joints which has never been reported in the literature till date.

Divergent Carpometacarpal Fracture Dislocation-An Uncommon Injury Pattern

Carpometacarpal fracture dislocation of the hand is a relatively uncommon injury pattern. This injury is difficult to diagnose clinically, because of gross hand swelling which may obscure the characteristic deformity. The diagnosis of this unusual injury pattern also requires lateral radiograph of the hand which is essential for making precise diagnosis in suspected cases. We are presenting a case of divergent carpometacarpal joint fracture dislocation of index, middle and ring fingers with associated fracture of base of proximal phalanx of thumb and base of thumb metacarpal bone. Closed reduction supplemented with Kirschner wire fixation restored normal carpometacarpal joint anatomical alignment and achieved excellent clinical result.

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

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.

Bilateral Carpometacarpal Joint Dislocations of the Thumb

A traumatic carpometacarpal joint dislocation of the thumb accounts for less than 1% of all hand injuries. Optimal treatment strategies for this injury are still a subject of debate. In this article, we report a case of bilateral thumb carpometacarpal joint dislocations: a unique combination of injuries. We believe our case is the second report of bilateral carpometacarpal joint dislocation regarding the thumb in English literature. It was successfully treated with closed reduction and percutaneous K-wires fixation on one side, and an open reduction and reconstruction of the ligament on the other side.

First Through Third Carpometacarpal Dislocation Variant With Trapezoid Dislocation And Trapezium Fracture

We describe a novel carpometacarpal (CMC) injury pattern of the 1st through 3rd rays with a thumb CMC dislocation, minimally displaced trapezium fracture, trapezoid dislocation and 3rd CMC dislocation. The injury was promptly identified and correctly characterized. Anatomic reduction and internal fixation for an appropriate time period allowed for soft tissue healing and a good short term outcome. We review the pertinent literature to carpometacarpal dislocations and contrast it to the presented case. Thumb CMC dislocation has not been previously reported in association with dislocations of the other rays.

Fourth and fifth carpometacarpal fracture and dislocation of the hand: new classification and treatment

Cain’s classification of fourth and fifth carpometacarpal (CMC) fracture and dislocation does not include the intraarticular metacarpal (MC) base fracture that may influence the treatment outcome. We reviewed 37 cases of fourth and fifth CMC fracture and dislocation treated with operative method, and we have devised a new classification based on the articular surface of the hamate and the involvement of the MC base. These injuries were divided into three types (type I, involved less than one-third of hamate articular surface; type II, involved more than one-third; and type III, coronal splitting of hamate). Each type was divided into four subtypes (a, absence of intraarticular MC base fracture; b, fourth MC base fracture; c, fifth MC base fracture; d, both fourth and fifth MC base fractures). Twenty cases were classified as type I, 16 as type II and 1 as type III. Stable hamate fracture (type I) was treated with closed reduction and percutaneous fixation, whereas unstable fracture (II and III) was treated with open reduction. Thirty-five of 37 patients showed excellent or good outcomes according to the Kumar’s criteria at 1 year postoperatively. The new classification classifies the fourth and fifth CMC fracture and dislocation in detail and appears to be more useful clinically.

Management of Carpometacarpal Dislocations in a College Football Athlete

Management of Carpometacarpal Dislocations in a College Football Athlete

Luxation carpo-métacarpienne divergente des doigts longs : à propos d’un cas

Divergent carpometacarpal joint dislocations of the fingers are exceptional. A 31-year-old judo player presented divergent carpometacarpal joint fracture-dislocations of the ulnar four fingers after a fall during competition. Radiographs showed dislocations and associated fractures. The patient underwent open reduction and fixation with percutaneous Kirschner-wires followed by 6 weeks immobilization. Physiotherapy was started and results were satisfactory after 3 years follow-up.

Luxations carpométacarpiennes fraîches des doigts longs. Étude à propos de 100 cas

Objectives The authors report clinical and radiological results of carpometacarpal dislocations treated in emergency over a period of 7 years (2002–2009). Mechanisms of injury and diagnosis pitfalls are specified, and treatment options are discussed. Methods A retrospective study of 100 carpometacarpal dislocations was performed. Most commonly trauma was a punch (56%). In half the cases, lesions were located only within the fifth ray. Carpal or metacarpal fractures were associated in a majority of cases (88%). Surgical treatment was carried out in all cases either by closed reduction and percutaneous pinning (60%), or by open reduction and internal fixation (40%). The mean follow-up was 5 months. Anatomic reduction of dislocation, consolidation and reduction of associated fractures were analysed on the last follow-up x-rays. Evaluation tools were pain score, range of motion and grip strength. Results Radiological criteria were satisfactory in 68% of cases. Non-satisfactory X ray criteria were mainly associated with closed reduction and percutaneous pinning. At final follow up, 81% of the patients were pain-free and had recovered complete range of motion. In 16% of patients pain was only found during grip strength test. Conclusions Carpometacarpal luxations are not as rare as suggested by literature. Early diagnosis and treatment are essential for the prognosis. Increasing indications of a scan enable better analysis by identifying all injuries. Open reduction by which allows the treatment of all associated injuries must be promoted.

Acute Ulnar Carpometacarpal Dislocations. Can it be Treated Conservatively? A Review of Four Cases

Dislocations of the ulnar carpometacarpal (CMC) joints are uncommon injuries. Initially, the injury is often overlooked or not found as an injury at all. Most cases presented in the literature advocate reduction with operative stabilization to prevent secondary dislocation. We present four cases of acute fourth and fifth CMC dislocations treated conservatively by closed reduction and splint immobilization.

Luxation carpo-métacarpienne du pouce associée à une fracture du trapèze et de Bennett

We report a case of a carpometacarpal joint dislocation of the thumb associated with trapezium and Bennett's fractures. This combined injury pattern appears to be very rare. To our knowledge, no such case was found in the literature. The patient had open reduction internal fixation with pins and screws, with good functional outcome.

La luxation dorsale carpométacarpienne des quatrième et cinquième doigts

The carpometacarpal dislocations are rare injuries. The authors report an unusual case of dorsal carpometacarpal joint dislocations of the ulnar two fingers, treated by closed reduction and fixation with percutaneous Kirschner-wires. A plaster splint with the wrist in neutral position was applied for six weeks. Active physiotherapy of the fingers was started from four weeks after surgery, with a satisfactory result.

Postoperative Management of Carpometacarpal Joint Fracture Dislocation of the Hand: A Case Report

Injury to the carpometacarpal joints is rare. The strong ligamentous attachments and carpal bone alignment readily resist displacement. To the authors' knowledge, there are no studies evaluating postoperative recovery regimens of carpometacarpal fracture dislocations. The present study describes a postoperative hand therapy regimen that used a novel carpometacarpal brace permitting early mobilization.

Combined Dislocation of the Trapezoid and Finger Carpometacarpal Joints—The Steering Wheel Injury: Case Report

Two cases of combined dorsal trapezoid dislocation and multiple finger carpometacarpal joint dislocations are described. In both cases, a common mechanism involved a head-on motor vehicle collision while the subjects held tightly to the steering wheel. The patients were treated with open reduction and pinning, with good short-term results.

Simultaneous bilateral third to fifth carpometacarpal joint dislocations; a boxing first?

Carpometacarpal joint dislocations (isolated and multiple) are uncommon hand injuries occurring in less than 1% of osseous hand injuries. Despite this, unilateral dislocations, with and without associated injuries, have been well-documented in the medical literature. We report the first case of bilateral third to fifth CMC joint dislocations occurring simultaneously in a 20-year-old boxer during a training session.

Isolated thumb carpometacarpal joint dislocation: a case report and review of the literature

BackgroundIsolated thumb carpometacarpal dislocation is a rare injury pattern and the optimal treatment option is still controversial.Case DescriptionWe present a 27-year-old basketball player who underwent an isolated dorsal dislocation of the thumb carpometacarpal joint after a fall. The dislocation was successfully reduced by closed means but the joint was found to be grossly unstable. Due to inherent instability, repair of the ruptured dorsoradial ligament and joint capsule was performed.The ligament was detached from its proximal insertion into trapezium and subsequently stabilized via suture anchors. The torn capsule was repaired in an end-to-end fashion and immobilization of the joint was applied for 6 weeks.ResultsAt 3-year follow up evaluation the patient was pain free and returned to his previous level of activity. No restriction of carpometacrpal movements or residual instability was noticed. Radiographic examination showed normal joint alignment and no signs of subluxation or early osteoarthritis.ConclusionSurgical stabilization of the dorsal capsuloligamentous complex may be considered the selected treatment option in isolated carpometacarpal joint dislocations, that remain unstable after closed reduction in young and high demand patients.Level of Clinical Evidence: Level IV

Simultaneous Dorsal Dislocations of the Carpometacarpal Joints of All Four Fingers

A 57-year-old right-hand-dominant woman was involved in a motor vehicle collision. Upon examination, her right hand was markedly deformed and swollen, with limited range of movement. Plain radiographs revealed dorsal dislocations of the index, long, ring, and small finger carpometacarpal joints and an avulsion fracture of the dorsal aspect of the capitate. Closed reduction was unsuccessful. Closed reduction under general anesthesia was successful on the carpometacarpal joint of the ring and small fingers, however, the long and index fingers remained irreducible. An open approach revealed that a joint capsule was interposed in the carpometacarpal joints of the long and index fingers, preventing reduction. Kirschner wires were placed through the base of the small and ring finger metacarpals into the carpus. Additional K-wires were placed across the base of the index and long finger metacarpals into the carpus, and removed at 6 weeks. The avulsion fracture of the capitate was not addressed. Follow-up at 24 months demonstrated full range of motion in all fingers. Her DASH Outcome Measure score was 1.7. She was pain free, had full grip strength, and returned to work full-time. Whether patients are treated closed or open, appropriate treatment of carpometacarpal dislocations usually leads to excellent outcomes. If closed reduction is unsuccessful, open treatment is required to address any soft tissue that is preventing reduction. Although urgent treatment is preferred, delay in reduction of up to 4 weeks has been shown not to compromise results.

Postoperative management of carpometacarpal joint fracture dislocation of the hand: A case report

Postoperative management of carpometacarpal joint fracture dislocation of the hand: A case report

Multiple carpometacarpal dislocations: case report and review of the literature

Multiple carpometacarpal dislocations: case report and review of the literature

Luxations spatulaires et lésions associées de la main et des deux os de l’avant-bras. À propos de deux cas

The authors report two cases of complete dorsal carpometacarpal dislocations associated with lesions of the hand and the two bones of forearm. These dislocations are rare, and their clinical and radiological diagnosis is difficult. These cases are original through the association of carpometacarpal dislocation with lesions of the two bones of forearm. They demonstrate the need to stress the importance of a complete evaluation of the patient. Treatment must be immediate and begin with the osteosynthesis of the proximal lesions to avoid any irreducibility. These elements will determine the functional outcome.