Simultaneous Dislocation of the Carpometacarpal and Metacarpophalangeal Joints of the Thumb in a Motorcyclist

Surgical Management of a Delayed Presentation of Floating First Metacarpal with Multiple Fracture Dislocations: A Case Report

CASE

A 23-year-old man presented with a 2-month-old injury involving a volar base metacarpal fracture dislocation of carpometacarpal joint (CMC), metacarpophalangeal joint (MP) dislocation, floating metacarpal, and proximal phalanx base fracture. Treatment involved open reduction of volar base metacarpal's fracture and CMC dislocation, MP joint reduction, collateral ligament repair, and proximal phalanx fixation with plates and screws. A modified Eaton-Littler procedure with flexor carpi radialis tendon enhanced CMC joint stability. At 6 weeks, fractures had healed well, achieving good thumb motion. One-year follow-up showed no arthritis or dislocation.

CONCLUSION

Thumb injuries are relatively common and can involve complex fractures and dislocations. Open reduction of the delayed fractures, dislocations, and ligament repair and reconstruction can lead to successful outcome.

Simultaneous quadruple dislocations of the hand in a motorcyclist: A case report

Herein we present a case of four simultaneous dislocations of the hand resulting from a motorcycle accident in a young man. In this case, the 1st CMC, MCP, and IP joints of the right hand were dislocated along with right perilunate dislocation. Perilunate dislocation was treated with open reduction and internal fixation. Close reduction of IP and CMC was done and CMC was fixed by pins. MCP dislocation was treated by open reduction and pinning in addition to collateral ligament and capsular repair. In follow-up excellent functional activity and range of motion were observed.

Management of thumb carpometacarpal joint dislocations: A systematic review

Although rare, thumb Carpometacarpal (CMC) joint dislocations can have significant complications which impact hand function. Optimal management is crucial in restoring pinch and grasp strength, but no agreement exists regarding treatment due to a paucity of literature on this subject. Systematic review was conducted involving non-operative and operative management of the CMC joint. 15 articles with a total of 60 thumbs were evaluated from published literature. 12/60 thumbs with isolated CMC joint dislocations were treated with closed reduction, with 4 cases needing additional ligament repair due to joint instability post-reduction. 51/60 of the isolated CMC joint dislocations had ligament reconstruction, with flexor carpi radialis tendon autograft (29/51) as the most popular option. 60/60 patients regained full function and stability of the CMC joint with significant pain relief. Although good surgical outcomes have been achieved, long term clinical outcome reporting is needed to develop a standardized approach to treatment.

Floating thumb metacarpal in a motorcyclist: A case report

We present a case of simultaneous dislocation of the carpometacarpal and the metacarpophalangeal joints of the thumb (floating thumb metacarpal) in a 47-year-old motorcyclist. The treatment consisted of closed reduction of both joints with cast immobilization. After 24 months, the functional result was excellent. The mechanism of this rare injury and its therapeutic management are discussed.

Floating thumb with double dislocation of carpometacarpal and metacarpo-phalangeal joints

INTRODUCTION

Double dislocations of carpometacarpal and metacarpo-phanlageal joints are rare. We report an unusual case of simultaneous dislocation of both CMC and MCP joints in the thumb.

PRESENTATION OF CASE

A 31 year old male was admitted following a road traffic accident. He was complaining of pain and deformity of right thumb. The X-ray examination revealed simultaneous dislocation of both CMC and MCP joints. He underwent closed manipulative reduction and percutaneous K wire fixation. The wires were removed after six weeks. After a course of physiotherapy he regained full range of pain free movements.

DISCUSSION

The incidence of simultaneous dislocation of both CMC and MCP joints in thumb are associated with high energy injuries. The options of treatment are conservative with cast immobilisation and serial X-rays or operative including closed manipulative reduction and K wire fixation or open reduction and internal fixation.

CONCLUSION

The option of treating this rare injury with closed manipulative reduction and percutaneous K wiring gives excellent and predictable results.

Complete dislocation of the thumb metacarpal with extreme displacement

This study reports a rare case of complete dislocation of the thumb metacarpal with extreme displacement. Although there are several reported cases of similar injury in earlier published reports, metacarpals of all the cases remained in situ. In this case, the metacarpal was totally displaced out of the hand. Although open reduction and internal fixation were performed, the clinical outcome was unsatisfactory because of severe soft tissue damage.

Nonoperative treatment for a double dislocation of the thumb metacarpal: a case report

Double dislocations of the thumb are rare injuries. Those reported in the English literature have all been treated operatively except one. We report the second case of a double dislocation of a thumb involving the metacarpophalangeal joint and carpometacarpal joint treated nonoperatively. Two-year results reveal a stable, pain free thumb with no evidence of arthritis or subluxation.