Radiographs (Figures 3 and 4) demonstrated a dorsal dislocation of the fourth and fifth metacarpals. Reduction was easily accomplished in the emergency department by simple traction with palmar pressure on the metacarpal heads, after analgesia. Carpometacarpal dislocations are quite uncommon and easily missed. The condition is typically associated with a significant amount of force, such as a fall from height, direct blow, or motor vehicle collision.1Eichhorn-Sens J. Katzer A. Meenen N.M. et al.[Carpometacarpal Dislocation Injuries].Handchir Mikrochir Plast Chir. 2001; 33: 189Crossref PubMed Scopus (13) Google Scholar Physical exam may reveal palpable masses on the dorsal aspect of the hand, but radiographs are key to making the diagnosis. The anterior-posterior radiograph will typically show overlap of the involved metacarpals over the carpals.2Emerson L.A. Total metacarpal dislocation.J Emerg Med. 2001; 20: 295-296Abstract Full Text Full Text PDF PubMed Scopus (4) Google Scholar The lateral film is most helpful, however, by showing dorsal displacement of the proximal metacarpal bones.Appropriate splinting and follow-up is indicated, as these reductions will often require Kirschner wire fixation to prevent re-dislocation. In extreme cases, open reduction and internal fixation may be needed if closed reduction is not successful, or if there are associated fractures.3Prokuski L.J. Eglseder Jr., W.A. Concurrent dorsal dislocations and fracture-dislocations of the index, long, ring, and small (second to fifth) carpometacarpal joints.J Orthop Trauma. 2001; 15: 549-554Crossref PubMed Scopus (26) Google ScholarIqbal, et al, recently described a technique termed the “Indian salutation test” to help evaluate for carpometacarpal dislocation.4Iqbal M.J. Saleemi A. Indian salutation test in acute dorsal carpometacarpal joint dislocation of the ulnar four fingers.Am J Emerg Med. 2003; 21: 74-76Abstract Full Text Full Text PDF PubMed Scopus (7) Google Scholar It involves placing the palms of the hands together with fingertips touching. The evaluator then examines for shortening of the digits of the injured hand. In the absence of fractures, this can be helpful in diagnosing this often-missed injury. Radiographs (Figures 3 and 4) demonstrated a dorsal dislocation of the fourth and fifth metacarpals. Reduction was easily accomplished in the emergency department by simple traction with palmar pressure on the metacarpal heads, after analgesia. Carpometacarpal dislocations are quite uncommon and easily missed. The condition is typically associated with a significant amount of force, such as a fall from height, direct blow, or motor vehicle collision.1Eichhorn-Sens J. Katzer A. Meenen N.M. et al.[Carpometacarpal Dislocation Injuries].Handchir Mikrochir Plast Chir. 2001; 33: 189Crossref PubMed Scopus (13) Google Scholar Physical exam may reveal palpable masses on the dorsal aspect of the hand, but radiographs are key to making the diagnosis. The anterior-posterior radiograph will typically show overlap of the involved metacarpals over the carpals.2Emerson L.A. Total metacarpal dislocation.J Emerg Med. 2001; 20: 295-296Abstract Full Text Full Text PDF PubMed Scopus (4) Google Scholar The lateral film is most helpful, however, by showing dorsal displacement of the proximal metacarpal bones. Appropriate splinting and follow-up is indicated, as these reductions will often require Kirschner wire fixation to prevent re-dislocation. In extreme cases, open reduction and internal fixation may be needed if closed reduction is not successful, or if there are associated fractures.3Prokuski L.J. Eglseder Jr., W.A. Concurrent dorsal dislocations and fracture-dislocations of the index, long, ring, and small (second to fifth) carpometacarpal joints.J Orthop Trauma. 2001; 15: 549-554Crossref PubMed Scopus (26) Google Scholar Iqbal, et al, recently described a technique termed the “Indian salutation test” to help evaluate for carpometacarpal dislocation.4Iqbal M.J. Saleemi A. Indian salutation test in acute dorsal carpometacarpal joint dislocation of the ulnar four fingers.Am J Emerg Med. 2003; 21: 74-76Abstract Full Text Full Text PDF PubMed Scopus (7) Google Scholar It involves placing the palms of the hands together with fingertips touching. The evaluator then examines for shortening of the digits of the injured hand. In the absence of fractures, this can be helpful in diagnosing this often-missed injury. Images in Emergency MedicineAnnals of Emergency MedicineVol. 46Issue 1PreviewA 24-year-old male tripped while walking down stairs, and fell on an outstretched, supinated right hand. Photographs of his hands are shown in Figure 1 and Figure 2. Full-Text PDF