Volar dislocation of multiple carpometacarpal joints: report of four cases

Multiple carpometacarpal joint fracture-dislocation from the second to fifth: A case report

Introduction

and importance: Herein we present a rare case of multiple second to fifth carpometacarpal joint fracture-dislocations. It is important in such cases to be aware of a high-velocity impact etiology of the fractures, which will ensure proper imaging, diagnosis and treatment.

Case presentation

A 34-year-old male presented with severe pain in his left hand following a motorcycle accident. He was diagnosed as multiple second to fifth carpometacarpal joint fracture-dislocations. He was successfully treated with closed reduction with multiple Kirshner wires fixation under general anesthesia. A one-year follow up confirmed excellent clinical results.

Clinical discussion

There are various surgical options including casting, closed reduction and percutaneous pinning (CRPP), and open reduction internal fixation, however, the optimal treatment is still controversial. The closed reduction is recommended in all CMC joint dislocations. Adding a K-wire fixation can create a secure fixation and achieve an excellent outcome.

Conclusion

Multiple carpometacarpal joint fracture-dislocations is a very rare injury. Careful clinical examination is important for an accurate diagnosis and plain radiographic studies are necessary. Standard fracture dislocation treatment can be used. Simple closed reduction with the K-wires fixation technique is easy to perform and in our case achieved successful treatment in terms of clinical and radiographic outcomes.

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Multiple carpometacarpal joint fracture-dislocations is a very rare injury.

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Careful clinical examination is important for an accurate diagnosis and plain radiographic studies are necessary.

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Simple closed reduction with the K-wires fixation technique is easy to perform and achieved successful treatment.

A Rare Case of Complex Carpal Injury: Divergent Trapezium-Trapezoid Fracture Dislocation

Background Divergent trapezium-trapezoid fracture dislocation is a rare and complex injury. The authors present an unusual case of dislocation of the trapezium-trapezoid complex with scaphoid fracture. Case Description A 25-year-old man suffered a road traffic accident leading to complex carpal injury due to axial and rotation forces (steer wheel injury) on the left wrist. X-rays and computed tomographic (CT) scan were done showing trapezium-trapezoid dissociation with fracture of distal pole of scaphoid and ulna styloid. The second metacarpal base was fractured with many ligamentous injuries in the wrist. Methods Volar flexor carpi radialis (FCR) approach was used to reduce and fix scaphoid fracture with 2.7-mm cannulated screw. Dorsal approach was used to fix fracture of second metacarpal base and perform reduction in trapezium-trapezoid complex with help of 0.8-mm K-wires, and suspension wiring of first to second and second to third metacarpal was done using 1.5-mm K-wires. The transverse flexor retinaculum (TFR) in this case was avulsed. Discussion The divergent trapezium-trapezoid joint with scaphoid fracture is not described in the literature yet. The authors implicate steering wheel injury pattern for such complex carpal fracture dislocations. CT scan is imperative to diagnose and plan treatment of such fracture morphology. Early fracture reduction and stabilization of carpal dislocations are essential for proper functioning of wrist.

Multiple Carpometacarpal Dislocations of the Hand - An Uncommon Variant: A Rare Case

Carpometacarpal fracture dislocations of the hand are a relatively uncommon injury. The injury is difficult to diagnose because of the gross swelling of the hand. The diagnosis of this unusual form of injury requires a high index of suspicion, vigilant examination and high-quality radiography. This article reports a case of young male grieved with dislocation of all carpometacarpal (CMC) joints due to motor vehicle collision. Standard radiographs and CT scan revealed dorsal dislocations of second to fourth CMC joints, volar fracture dislocation of fifth carpometacarpal joint, fracture dislocation of CMC joint of thumb and dorsal dislocation of the trapezoid. Patient was treated with closed manipulation and percutaneous pinning with multiple K - wires. Follow up radiographs showed adequate reduction and fracture union. Intensive postoperative physiotherapy is vital for achieving a good outcome.

Multiple Volar Carpometacarpal Dislocations: Case Report/Review of the Literature

Simultaneous volar dislocations of the second through fifth carpometacarpal joints are rare injuries, usually a result of high-energy trauma to the hand. The literature regarding this topic is sparse and consists primarily of case reports. We present a case associated with median nerve contusion that was treated with open reduction and pin fixation. The median nerve injury resolved without incident, and the pins were removed at 10 weeks without loss of reduction. Three years postoperatively, the patient was without pain and had excellent use of his hand without strength or motion deficit.

Carpometacarpal Joint Fracture Dislocation of Second to Fifth Finger

Background

Carpometacarpal joint fracture dislocation of the second to fifth finger is a rare hand injury associated with high energy trauma. Due to severe swelling and overlapping of bones on the radiograph of wrist-hand, dislocations are missed. We reported a series of six patients with rare carpometacarpal joint fracture dislocation treated with open reduction.

Methods

We retrospectively studied six cases of carpometacarpal joint fracture dislocation. All patients were treated with open reduction and internal fixation with Kirschner wire. Functional assessment was done with Quick Disabilities of the Arm, Shoulder and Hand score (Quick DASH score) at regular intervals.

Results

Average Quick DASH score was improved from 75.76 to 1.9 from 6 weeks to 18 months of duration. Of the six patients, three patients had a Quick DASH score of 0 at the end of 18 months.

Conclusions

Careful hand examination and radiographic assessment is necessary to avoid missed diagnosis of carpometacarpal joint fracture dislocation. Early open reduction and internal fixation lead to excellent recovery of hand function.

Various Diagnostic and Treatment Pitfalls of Combined Fracture Dislocations of Trapezoid and Multiple Carpometacarpal Joints

We report a rare case of combined fracture dislocations of the trapezoid and multiple carpometacarpal joints that became chronic due to inappropriate treatments. Although an acceptable clinical result was obtained with limited intercarpal fusion, correct diagnosis and initial treatments including anatomical reduction and fixation for obtaining a good clinical result, are important for complex trapezoid injury.

[Volar dislocation of the fifth carpometacarpal joint: a case report]

Pure carpo-metacarpal dislocations without any fracture are rare, their volar component is exceptional. Untreated injuries can result in instability and early articular degeneration. We report a 72-year-old female patient who underwent an isolated closed volar dislocation of her fifth finger carpo-metacarpal joint after a fall. The clinical examination showed a 10°-defect in rotation with limited adduction (radial deviation). The X-rays showed a gap between the base of the fourth and the fifth metacarpal bones with volar dislocation of the base of the fifth carpometacarpal joint. The dislocation was successfully treated by closed reduction maintained with two K-wires. Immobilisation of the joint was applied for 6 weeks. At 2 years follow-up evaluation, the patient was pain free with no clinico-radiological evidence of instability and had returned to her previous level of activity.

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.

[Combined carpometacarpal dislocations, hand lesions and fractures of the two bones of the forearm: a report of two cases]

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.

Volar dislocation of the fourth and fifth carpometacarpal joints: a case report and review of the literature

We report the treatment of a volar dislocation to the fourth and fifth carpometacarpal (CMC) joints. Plain radiographs were used to evaluate this unusual injury before surgery. Open reduction and internal fixation using K-wires restored the normal anatomic relationships of the CMC joints. This very rare injury is often difficult to recognize. A careful neurologic assessment of the patient is a necessity, as well as obtaining proper radiographs of the hand. A review of the literature is presented.

[Total carpometacarpal dislocations. Two case reports]

We report two cases of carpometacarpal dislocation of the four long fingers. They were diagnosed in emergency and treated by open reduction and stabilization by intramedullary pinning. They were followed for an average of 30 months. The results were rated good, and the two patients had an excellent grip strength, no deformity, no instability, no disabling or limited prehension. Dislocation or fracture-dislocation of the carpometacarpal joints are uncommon injuries. The diagnosis can be easily missed. The authors recommend closed or open reduction and fixation by pins and immobilisation in a plaster cast. The results was good in the two cases without complications.