Isolated first carpometacarpal joint dislocation managed with closed reduction and splinting

Systematic Review of Ligament Reconstruction of Traumatic Isolated Thumb Carpometacarpal Joint Dislocation

INTRODUCTION

Thumb carpometacarpal (CMC) joint dislocations are rare with minimal agreement on surgical management. The dorsoradial ligament (DRL) is the primary joint stabilizer but has not historically been reconstructed. We hypothesize that the reported reconstruction of first CMC joint dislocations primarily uses the flexor carpi radialis (FCR) without collective agreement on a surgical technique.

METHODS

A systematic review of the PubMed database from 1996 to 2022 was done. Keywords were "thumb dislocation," "thumb carpometacarpal dislocation," and "carpometacarpal joint ligament repair." Inclusion criteria included isolated, unstable thumb CMC dislocations with reconstruction. The Preferred Reporting Items for Systematic Reviews and Meta Analyses guidelines were used.

RESULTS

Four hundred thirty-seven records were identified, and nine met inclusion criteria. Two articles were cohort studies, and seven were case reports. Thirty-seven patients were included, and 26 patients had reconstruction with tendonous autograft. Twenty-five (96.2%) used the FCR and 1 (3.9%) from the palmaris longus. Three patients had reconstruction with a suture anchor. Surgical techniques varied between studies.

DISCUSSION

The recommendation of the authors recreates the DRL during autograft repair. Current repair techniques that recreate the DRL use the FCR, but quantitative comparisons of tendonous autografts or suture anchors have not been done.

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.

Early Recognition and Treatment of Carpometacarpal Fractures and Dislocations

Carpometacarpal (CMC) injuries can easily be missed in more than half of the cases. Early diagnosis is crucial for treatment. Although the clinical aspect can lead the treating physician to suspect that anything is going wrong, appropriate radiographs, especially in the lateral view, are crucial for the diagnosis. The most common CMC fracture dislocations affects the 4 ^th and 5 ^th joints. Treatment will depend on the type of injury and on the degree of joint involvement. Reduction and fixation are usually required. When only one ray is affected, usually the 5 ^th , closed reduction and fixation with Kirschner wires can be performed. In complex cases, open reduction and fixation are required, with Kirschner wires being the most commonly used materials. After the hardware removal, rehabilitation can be intensified. If an appropriate reduction has been achieved, satisfactory functional and radiological outcomes are expected.

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.