Complex dorsal dislocation of the second carpometacarpal joint

Ho, Paul K.; Choban, Stephen J.; Eshman, Stephen J.; DuPuy, Theodore E.

doi:10.1016/s0363-5023(87)80115-6

Cited by 17 publications

(11 citation statements)

References 6 publications

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“…2 • 3 ,7,11 Of these 11, five are reported in the English literature'>" and three of these required open reduction. 3 ,lo, 11 To the best of our knowledge, our case represents only the third closed reduction of a second carpometacarpal dislocation in the English literature.…”

Section: Anatomymentioning

confidence: 84%

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Second Carpometacarpal Joint Dislocation: An Impossible Situation?

Santini

Douglas²

1998

Int J Clinical Practice

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SUMMARY We report a case of a seemingly anatomically impossible dislocation of the second carpometacarpal joint treated by closed manipulation, and a review the literature. Isolated second carpometacarpal joint dislocation is rare, whereas dislocations of the first, fourth and fifth joints are more common. A true lateral X‐ray is necessary if the injury is suspected clinically. We recommend that closed reduction under local anaesthetic is attempted, although the patient should be warned that subsequent open reduction may be necessary if closed reduction fails. Chronic unreduced dislocations do not produce serious disabilities in the hand.

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Section: Anatomymentioning

confidence: 84%

“…Dorsal to the trapezial articulation is the insertion of the extensor carpi radialis longus. This strengthens the dorsal aspect of the second carpometacarpal joint 3 . The extensor carpi radialis brevis lies deep to the longus muscle and is inserted into the radial side of the third metacarpal base.…”

Section: Anatomymentioning

confidence: 88%

Second Carpometacarpal Joint Dislocation: An Impossible Situation?

Santini

Douglas²

1998

Int J Clinical Practice

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“…The index carpometacarpal joint is a structurally stable joint because of its intrinsic bony stability through interlocking articular surface anatomy, strong volar, dorsal and intermetacarpal ligaments and peri-articular tendinous support (Van der Lei and Klasen, 1992). This dislocation is rare, with only two previous reports in the English literature (Carnerio and Rancatore, 2000; Ho et al, 1987). It also requires considerable energy, as a consequence of which it is often associated with concomitant fractures of either the metacarpal base or the carpal bones (Lawlis and Gunther, 1991).…”

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confidence: 83%

“…This dislocation is rare, with only two previous reports in the English literature (Carnerio and Rancatore, 2000;Ho et al, 1987). It also requires considerable energy, as a consequence of which it is often associated with concomitant fractures of either the metacarpal base or the carpal bones (Lawlis and Gunther, 1991).…”

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confidence: 99%

Re: Irreducible dorsal dislocation of the index carpometacarpal joint

Köse

Islam

2008

J Hand Surg Eur Vol

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A 40 year-old man was admitted as an emergency after a fall on his dominant right hand in which he struck the ground with the dorsum of his hand with his wrist flexed. He had marked swelling of the dorsum of the hand at the base of the index metacarpal and internal rotation of the index finger, with a dorsal bony prominence and tenderness over the index metacarpal base. Motion of this finger and dorsiflexion of the wrist were both restricted and painful. X-rays of the hand revealed an isolated dorsal dislocation of the index carpometacarpal joint without fracture (Fig 1). Several attempts at closed reduction failed. Under local anaesthesia, through a dorsal incision, the radial extensors of the wrist were isolated. The extensor carpi radialis brevis (ECRB) tendon was found to be interposed between the base of the index metacarpal and the trapezoid (Fig 2). The tendon was retracted to the ulnar side and the joint reduced. A plaster cast only was applied for 4 weeks, following which he had 3 weeks of grip-strengthening exercises. At 2 months, he was pain free, had normal ranges of motion of his wrist and finger joints and returned to work. At 2 years, he was able to perform strenuous manual work without any discomfort.The index carpometacarpal joint is a structurally stable joint because of its intrinsic bony stability through interlocking articular surface anatomy, strong volar, dorsal and intermetacarpal ligaments and periarticular tendinous support (Van der Lei and Klasen, 1992). This dislocation is rare, with only two previous reports in the English literature (Carnerio and Rancatore, 2000;Ho et al., 1987). It also requires considerable energy, as a consequence of which it is often associated with concomitant fractures of either the metacarpal base or the carpal bones (Lawlis and Gunther, 1991). The probable mechanism of injury in this case was force transmission along the index metacarpal when the head of this bone struck the ground, with hyperflexion of the carpometacarpal joint levering out the base of the metacarpal dorsally. The ECRB tendon lies over the joint just proximal to its insertion, mainly into the third metacarpal base. ECRB entrapment is more likely when an internal rotatory component is added to the metacarpal dislocation (Mehara and Bhan, 1993). Fig 1 Preoperative anteroposterior and lateral X-ray views of the patient's hand. Dorsal dislocation and internal rotation of the index metacarpal are seen. Fig 2 Intra-operative photograph showing the interposed ECRB tendon between index metacarpal base and trapezoid.

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“…Subluxation or dislocation of a carpometacarpal joint other than of the thumb is uncommon (Ho et al, 1987) because of strong ligamentous and bony stabilizers, and the diagnosis may easily be overlooked. A report of carpometacarpal dislocations by Henderson & Arafa in 1987 showed 15 of 21 patients reviewed had the diagnosis missed in the accident and emergency department and furthermore the injury was missed again in five cases when they were reviewed by the senior registrar or consultant in orthopaedic surgery.…”

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confidence: 99%