A Review of the Diagnosis and Management of Index through Fifth Carpometacarpal Dislocations

Abstract

Dislocation of all four ulna-sided carpometacarpal (CMC) joints (index through to 5th) is a rare injury pattern in the hand. Diagnosis is often delayed due to the attending health care practitioner's unfamiliarity of the anatomy, pathology and radiological interpretation at initial assessment. A timely diagnosis is often met with a relatively straight-forward reduction whereas delays lead to great management difficulties and poor patient functional outcomes. There are arguments for and against various approaches in management of this injury spectrum however there is consensus that early diagnosis, treatment and rehabilitation yields good results for majority of the patients. Salvage procedures for delayed treatment tend to have poorer prognosis, thus further emphasising the need for diagnosis at the earliest possible point. The rarity explains the relative underrepresentation of this injury spectrum in medical literature. This review aims to educate the reader on various aspects that could lead to better understanding and aid an earlier diagnosis and options for management of this rare injury spectrum. Citation