Dislocation Of Carpometacarpal Joint Research Articles

Complex Axial Carpal Dislocation with Scapholunate Ligament Injury

Abstract Background Axial carpal dislocations (ACDs) are high-impact injuries, involving both proximal and distal carpal rows, adding complexity to the diagnostic and treatment challenges. This article explores a distinctive case of axial radial carpal dislocation, highlighting an irreducible second carpometacarpal joint (CMCJ) and concomitant scapholunate (SL) ligament injury. Understanding the background of axial carpal injuries is crucial for recognizing and addressing these complex cases effectively. Description A 27-year-old man presented with a left wrist injury following a motorcycle accident, revealing an irreducible second CMCJ with a unique ligamentous injury pattern. Despite unsuccessful closed reduction attempts, the surgical intervention involved a dorsal midline incision, fixation of the second CMCJ and SL interval, and ligament repair. Postoperative assessment demonstrated proper alignment with a mild gap in the SL interval, revealing the intricate nature of the injury. Literature Review Existing studies describe a type of axial dislocation starting at the third webspace, traveling through capitate–hamate intervals leading to scaphoid dislocation. However, in the article, we describe a variant of ACD through second CMCJ causing an SL interval instability. Clinical Relevance Recognizing and comprehensively addressing axial radial carpal dislocations are crucial for optimal patient outcomes. The case report contributes valuable insights into the rare pattern of ACD involving SL instability that was missed on initial radiographs but detected through computed tomography scan and thereby managed appropriately. Any CMCJ dislocation should raise a suspicion of axial dislocation unless proved otherwise.

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.

Isolated dorsal dislocation of the 5th carpometacarpal joint; a missed injury

Introduction: 5th carpometacarpal (CMC) joint dislocations of the wrist region are very rare and easily overlooked injuries. In this type of injury, which causes serious functional problems in the hand if not treated appropriately, closed methods are generally used in the treatment. In this study, we present a case with fracture-dislocation of the 5th CMC joint. 
 Case: Fracture-dislocation of the 5th CMC joint of a 25-year-old patient who was admitted to the emergency department due to wrist pain was not noticed. The diagnosis was made during the follow-up of the patient, and the joint was reduced with closed method and fixed with a K wire. No serious problems were encountered in the patient's controls.
 Conclusion: Undiagnosed 5th CMC joint dislocation disrupts the transverse and longitudinal arches of the hand, so the patient has a weak and painful gripping function. Radiological findings may be unclear on anterior-posterior and lateral views, and additional images may be obtained if in doubt.

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.

Dorsal Second and Third Carpometacarpal Joint Dislocation: A Case Report

Dorsal Second and Third Carpometacarpal Joint Dislocation: A Case Report

Ulnar dislocation of the fifth carpometacarpal joint

Ulnar dislocation of the fifth carpometacarpal joint

Isolated ulnopalmar dislocation of 5th carpometacarpal joint: a rare case report

<p class="abstract">Isolated volar dislocations of the fifth carpometacarpal joints are an uncommon injury. They are classified as ulnopalmar or radiopalmar dislocations. It can be easily missed on standard radiographs. A high degree of suspicion and accurate reduction is pivotal in restoring the functional outcome of the hand. In our case report, a forty year old man presented with ulnopalmar dislocation of the fifth carpometacarpal joint and was treated with open reduction and K wiring. We review the literature and discuss the available methods of management.</p>

Blast Injury to the Hand: Assessing the Injury Pattern and Functional Outcome of the Thumb.

Background:In the United States, approximately 30% of about 10,000 annual blast injuries involve the hand, causing a broad spectrum of injury severity. The first web space is typically most severely affected. As the carpometacarpal (CMC) joint is critical to the unique function of the thumb, we evaluated typical patterns of injury to this joint, subsequent salvageability and functional outcomes of the thumb.Methods:We conducted a retrospective chart review on patients with blast injuries to the hand from January 1995 through July 2019 and excluded penetrating trauma. We assessed hand function as reported in occupational therapy records. Injury severity was classified independently by structures.Results:Twenty-one patients were included, two with bilateral injuries, for a total of 23 hands. Eighteen patients had injuries to one or both thumbs, for a total of 20 thumbs evaluated. Average follow-up was 1.58 years. Most injuries qualified as severe in at least one category: soft tissue, neurovascular, or bone/joint. All 10 CMC joint dislocations required surgical fixation and pinning. Eight patients had applicable occupational therapy notes available. Severely injured thumbs had statistically significant decreased range of motion (ROM) at the interphalangeal joint, metacarpophalangeal joint and with radial abduction compared to mildly injury thumbs (P value 0.02, 0.03, 0.04, respectively).Conclusions:Blast injury to the hand often results in severe deficits, frequently affecting thumb functionality and irreversibly altering occupational capabilities. Half the patients studied had severe damage to the thumb CMC joint. Objectively, severely injured thumbs had significantly worse ROM than mildly injured thumbs.

Fracture in the body of the hamate bone with associated dislocation in the fourth carpometacarpal joint: a case report

Fractures of the hamate bone associated with dislocations of the 4th and 5th carpometacarpal joints are uncommon. They usually occur due to high-energy injuries, i.e., in the course of multi-trauma. A case of a young man who sustained such an injury after punching a wall is reported. Operative treatment consisted of a reduction in the dislocation of the 4th carpometacarpal joint followed by a stable fixation of the hamate bone with lag-screws. This allowed recovery to normal function in the hand 3 months post-injury.

The Measurement of the Inclination Angle of the Hamate and Analysis of the Inclination Angle for the Rotation Deformity of the Little Finger in the Fixation of the Carpometacarpal Joint.

ObjectiveComplex base fractures of the fifth metacarpal bone and dislocation of the fifth carpometacarpal joint are more prone to internal rotation deformity of the little finger sequence after fixation with a transarticular plate. In the past, we have neglected that there is actually a certain angle of external rotation in the hamate surface of transarticular fixation. This study measured the inclination angle of the hamate surface relative to the fifth metacarpal surface for clinical reference.MethodsIn a prospective single‐center study, we investigated the tilt angle of 60 normal hamates. The study included thin‐layer computed tomography (CT) data from 60 patients from the orthopaedic clinic and inpatient unit from January 2017 to March 2020, including 34 men and 26 women who were 15~59 years old, average 35 years old. The CT data of 60 cases in Dicom format of the hand was input into Mimics and 3‐Matics software for three‐dimensional (3D) reconstruction and measuring the angle α between hamate surface and the fifth metacarpal surface. According to the possible placement of the transarticular plate on the fifth metacarpal surface, we measured the angle β between the hamate surface 1 and the fifth metacarpal surface and the angle γ between the hamate surface 2 and the fifth metacarpal surface.ResultsThe average angle between the hamate surface and the fifth metacarpal surface was 11.66°. The hamate surfaces 1 and 2 have an external rotation angle of 7.30° and 7.51° on average with respect to the fifth metacarpal surface, respectively. There is no statistically significant difference in the angles between the two groups (P > 0.05).ConclusionsThe horizontal angle of the dorsal side of the hamate is different from the back of the fifth metacarpal surface, and the hamate has a certain external rotation angle with respect to the fifth metacarpal surface. No matter how the transarticular plate is placed, the plate always has a certain external rotation angle relative to the fifth metacarpal surface. When the fixation is across the fifth carpometacarpal joint, if the plate does not twist and shape, it will inevitably cause internal rotation of the fifth metacarpal, resulting in internal rotation deformity of the little finger sequence.

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.

Isolated Dorsal Dislocations of the Fourth and Fifth Carpometacarpal Joints: A Case Report and Review of Literature

Dislocations of the carpometacarpal (CMC) joints without fracture are rare injuries. They commonly involve the fourth and fifth metacarpals of the dominant hand. Missed and incorrect diagnoses are quite frequent due to subtle clinical and radiological findings. Untreated cases may result in chronic disability due to long term pain and weakness in grip strength. Closed reduction is possible when performed early but can be unstable. We present a rare case of unstable dislocation of fourth and fifth carpometacarpal joints treated by closed reduction and percutaneous pinning.

Carpometacarpal Joint Dislocations: Management and Long-Term Outcomes at a Specialized Hand Surgery Center in Latin America.

Carpometacarpal joint dislocations are uncommon hand injuries. These dislocations are usually misdiagnosed due to their non-specific clinical signs and tend to be difficult to identify in simple X-rays. We report our experience in the management of carpometacarpal bone dislocations at a specialized hand surgery center. Patients with carpometacarpal dislocations seen at the emergency department between 2013 and 2017 were included. All patients were treated with either closed reduction and percutaneous pinning (CRPP) or open reduction and internal fixation (ORIF). Postoperative functional assessment was performed at 6 and 18 months using the Disabilities of the Arm, Shoulder, and Hand (DASH) score. Eleven patients were included, 8 (72%) were managed with CRPP and the rest required ORIF (28%). For the functional outcome, we found an average DASH score of 27.9 at the 6 months threshold and of 1.5 at the 18 months threshold. Carpometacarpal dislocations are uncommon and easy to misdiagnose; the hand surgeon should have a high clinical suspicion in patients who sustained high-energy trauma, and imaging studies should be thoroughly evaluated. Closed reduction and percutaneous pinning is a safe and effective treatment option, with long-term good functional results.

Dislocation of the Hamatometacarpal Joint: About a Rare Case

Pure isolated dislocation of the hamatometacarpal joint is extremely rare. Herein we reported a rare case of pure isolated dislocation of the fifth carpometacarpal joint which was successfully treated surgically. Although, the hamatometacarpal dislocations are uncommon and frequently missed, a high index of suspicion combined to adequate radiological assessment usually ascertain the diagnosis.

Dislocation of the first carpometacarpal joint

First carpometacarpal (CMC1) joint dislocations are uncommon injuries. However, they can limit hand functions and lead to serious complications. Herein, we report the case of a multiple trauma man with dorsal dislocation of thumb CMC joint that was successfully treated with closed reduction and casting. The patient was a 47-year-old male with multiple traumas complaining of right wrist pain. Tenderness, deformity, and reduced range of motion of the right thumb CMC joint were observed. X-ray showed dorsal dislocation of the CMC1 joint. Closed reduction of the dislocated joint was performed under general anesthesia, and the joint was immobilized by a thumb-spica cast for 14 days. The patient was eventually discharged in good condition and had no complications or manual dysfunction after a 1-month follow-up. The optimal management of the CMC1 joint dislocations is controversial. The closed reduction seems adequate for these injuries. However, patients whose joints remain unstable after closed reduction, especially those with manual activities, should be considered for open reduction and surgical ligament repair.

Ligament Reconstruction of Traumatic Pure Dislocation of Carpometacarpal Joint of the Thumb: A Series of Acute and Chronic Cases

Background Traumatic instability of carpometacarpal (CMC) joint of the thumb without a fracture (pure dislocation of CMC joint) is an uncommon injury, and a universally accepted protocol has not yet been developed for its management. Here, we aim to evaluate the outcome of this injury managed with ligament reconstruction technique, in a series of acute and chronic injuries.Patients and Methods Total nine patients (six acute and three chronic) with pure dislocation of CMC joint who underwent ligament reconstruction surgery were included in this retrospective study. Outcome measures included disabilities of the arm, shoulder, and hand (quick-DASH) questionnaire; visual analog scale (VAS) scoring system; patient-rated wrist/hand evaluation (PRWHE) system; pinch and grip strength; and Kapandji thumb opposition scores.Results The patients’ mean age was 32.55 ± 11.4 years. Their mean follow-up period was 27 ± 12.8 months. The mean postoperative pinch and grip strength was equivalent to 91.5% and 108% of the contralateral hand, respectively. The mean Quick-DASH score was 14.7 ± 19.4. The mean PRWHE score was 18.7 ± 22.4. The mean VAS was 1.1 ± 1.5. The mean Kapandji score was 8.3 ± 1.4. The pinch and grip strength were considerably superior in acute injuries. Degenerative changes were seen in all joints at the latest follow-up. None of our patients needed a revision surgery.Conclusion Ligament reconstruction method could result in favorable outcome in the management of pure dislocation of CMC joint. However, delayed surgery of this injury might adversely affect the outcome measures.

Application of dorsal supporting plate for treatment of the fourth and fifth carpometacarpal joint fractures and dislocations

Objective To report the clinical efficacy of dorsal lateral supporting plate in the treatment of the fourth and fifth carpometacarpal joint fractures and dislocations. Methods From June 2010 to May 2017, 7 patients with the fourth and fifth carpometacarpal joint fractures and dislocations were treated by dorsal lateral supporting plate and Kirschner wire fixation. The fractures of the hamate bone were all Cain type Ⅱunstable fractures, including 1 case of type ⅡA, 4 cases of type Ⅱ B, and 2 cases of type Ⅱ C. Among them, 2 cases had the base of the fourth and fifth metacarpal bone fractures, and 2 cases had only the base of the fourth metacarpal bone fracture. Results All the wounds achieved primary healing. The fracture healing time ranged from 8 to 12 weeks. The internal fixation was taken out depending on the healing of the fracture. All the patients were follow-up from 5 to 12 months with an average of 7 months. The flexion and extension function of all the hand joints recovered well. According to the upper extremity function evaluation criteria issued by the Hand Surgery Society of the Chinese Medical Association, the results were rated as excellent in 4 cases and good in 3 cases. Conclusion The treatment of fractures and dislocations of the fourth and fifth carpometacarpal joints with dorsal supporting plate and Kirschner wire fixation can provide stable fixation in multiple planes and directions, which is helpful for early functional exercise. Key words: Hamate bone; Carpometacarpal joints; Fractures,bone; Dislocations

Floating Thumb with Simultaneous Carpometacarpal and Metacarpo-phalangeal Dislocation: A Case Report

Double dislocation of carpometacarpal and metacarpo-phalangeal joints of thumb is also called ‘floating thumb metacarpal’. This rare injury usually presents with combined joints dislocation and collateral ligaments rupture, which may be predisposing to joint instability after closed reduction. We report a case of traumatic and chronic dislocation of carpometacarpal and metacarpo-phalangeal joints of left thumb in a 63-year-old housewife. Failure of non-operative treatment was found up to 1 month after injury due to missed follow-up. Closed reduction was tried but failed because of joints stiffness. Open reduction and K-wire fixation were performed and radial collateral ligaments were repaired. Patient restored good functional outcome with no evidence of arthritis or subluxation at 1 year. Open reduction and fixation show good result in our case with delayed surgical intervention. The management of a floating thumb could be non-operative by close reduction and cast immobilization. However, closed monitoring and regular follow-up are critical after non-operative treatment to avoid potential risk of post-operative complications.

Surgical Repair of Dorsal Capsulo-Ligamentous Complex for Dislocation of the Thumb Carpometacarpal Joint

Background: Acute dislocation of the thumb carpometacarpal (CMC) joint is a rare and challenging injury, and its treatment remains controversial. The purpose of the study was to evaluate the clinical outcome after surgical repair of the dorsal capsulo-ligamentous complex. Materials and methods: Eight patients with a mean age of 39.8 years (range, 23 - 56 years) treated for the thumb CMC joint were treated in our hospital between 2008 and 2018. The ruptured dorsal capsulo-ligamentous complex was repaired using suture anchors in all patients, and the joint was immobilized with a Kirschner wire pinning and splint for 3 weeks. The clinical outcome was assessed by measuring the range of motion of the thumb CMC joint and the Japanese Society for Surgery of the Hand version of the Quick Disability of the Arm, Shoulder, and Hand (Q-DASH-JSSH) score. Results: The mean radial abduction of the thumb CMC joint was 66°, and the volar abduction was 63°. The mean Q-DASH-JSSH score was 4.8 (range, 0 - 15.6). There were no cases of infection, nerve disturbance, or osteoarthritis. Anatomical reduction was observed in seven patients at the final follow-up and in a rugby football player at 6 months of follow-up; however, subluxation of the thumb CMC joint at 12 months of follow-up due to reinjury was observed. Conclusion: Surgical repair of the dorsal capsulo-ligamentous complex with suture anchors is a reliable and simple treatment for acute unstable dislocation of the thumb CMC joint.