Trapeziometacarpal dislocation without fracture

Internal brace augmentation improves the biomechanical properties of trapeziometacarpal joint dorsoradial ligament repair

This study investigated whether dorsoradial ligament repair with internal brace augmentation provided more immediate stability in the trapeziometacarpal joint than dorsoradial ligament repair alone. Seven matched pairs of cadaveric hands were used. One specimen from each pair was assigned to the repair-only group and the other to the repair + internal brace augmentation group. Trapeziometacarpal joint range of motion and translation were quantified under different conditions for both groups: (1) intact, (2) transected dorsoradial ligament, and (3) repaired dorsoradial ligament or repaired dorsoradial ligament plus internal brace augmentation. Load-to-failure tests were performed after repair. Range of motion and translation were increased by dorsoradial ligament transection and were decreased by dorsoradial ligament repair; however, compared to the intact condition, the repair-only group demonstrated greater flexion/extension range, while the repair + internal brace group showed no significant difference in range of motion. Mean loads at 2- and 3-mm displacements were greater in the repair + internal brace group than in the repair-only group (18.0 ± 1.8 N vs. 10.8 ± 1.3 N for 2 mm displacement and 35.3 ± 3.7 N vs. 23.1 ± 2.9 N for 3 mm displacement, respectively). Internal brace augmentation improved the load-to-failure characteristics of dorsoradial ligament repair without compromising range of motion. LEVEL OF EVIDENCE: IV.

Management of Acute and Chronic Thumb CMC Joint Dislocations

Isolated dislocations of thumb CMC joints are rare injuries with serious functional implications. Patients suffering these injuries will have decreased pinch and grip strength. A high-energy, axially directed force on a flexed thumb typically causes dislocation. Chronically dislocated thumb CMC joints may be due to untreated remote trauma, hypermobility, or connective tissue disorders. Roberts and CMC stress view radiographs help identify joint dislocations. Treatment of these injuries includes closed reduction and immobilization, percutaneous pinning, open reduction with direct repair, and ligament reconstruction. Timely identification, timely treatment, and proper hand therapy often lead to adequate joint stability with minimal residual pain.

Traumatic Isolated Thumb Carpometacarpal Joint Dislocation - Report of Two Clinical Cases

Isolated thumb carpometacarpal joint dislocation is a rare lesion that accounts for less than 1% of all hand lesions.

The authors present two cases of traumatic isolated thumb carpometacarpal joint dislocation. One of them was treated with closed reduction and cast immobilization, and the other was treated with closed reduction, Kirschner-wires pinning, and cast immobilization.

The first patient had a good functional outcome and showed no signs of thumb carpometacarpal instability. The patient treated with Kirschner wires presented signs of clinical instability and radiological subluxation.

Isolated thumb carpometacarpal dislocation is a rare lesion that can cause joint instability, 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.