Divergent dislocation of the carpometacarpal joints: a case report

Hani, Redouane; Jeddi, Idriss; Berrada, Mohamed Saleh

doi:10.1186/s13256-018-1695-y

Cited by 5 publications

(5 citation statements)

References 10 publications

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“…[10][11][12] A high-energy mechanism of injury is usually needed for the disruption of the strong ligamentous support of the CMC joint, consisted of a system of four ligaments, namely the dorsal metacarpal, the volar metacarpal, and the two sets of interosseous ligaments. 8,[13][14][15] The most common causes are a blow with clenched fist (about half of the patients in three case series in literature), a fall from height, and car and motorcycle accidents. 2,5,9,16 CMC dislocations are notoriously overlooked injuries during the initial evaluation (up to 71% according to Hen-derson and Arafa).…”

Section: Discussionmentioning

confidence: 99%

Delayed Diagnosis of Dislocation of All Four Ulnar Carpometacarpal Joints. Surgical Treatment Strategy and Challenges.

et al. 2023

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Background Carpometacarpal dislocations are rare injuries whose diagnosis is often missed initially. These injuries can be treated conservatively, as long as an anatomical closed reduction is achieved. However, in most cases, open reduction followed by internal or external fixation is necessary to reach a stable anatomical reduction. Case Description A 32-year-old male was referred to our institution due to excess swelling of his right hand, 2 months after a motorcycle crash he sustained. During our imaging workup, a dorsal carpometacarpal dislocation of all four ulnar metacarpals was found accompanied by a fracture of the base of the fifth metacarpal. An open reduction was achieved using Kirschner wires and a small plate for arthrodesis of the fifth carpometacarpal joint. The postoperative follow-up on the 3rd, 6th, and 12th month was uncomplicated. The range of motion and grip strength was satisfactory on the 3rd month and almost full on the 6th month compared to the unaffected side. Literature Review Carpometacarpal dislocations are rare hand injuries. They are often the result of a high-energy injury and their diagnosis is usually delayed or missed. The main reasons are the excessive pain and swelling of the hand which make the initial clinical examination difficult and the overlapping of the metacarpals on the X-ray, which make the radiological diagnosis challenging. Case Relevance A delayed diagnosis needs urgent open surgical treatment to achieve an anatomical reduction due to the interposition of soft tissue, bony fragments, and newly formed callus. Diagnosis and treatment of these injuries demands a high clinical suspicion from the traumatologist. The role of computed tomography scan is invaluable and open reduction is the mainstay of treatment for the cases that are diagnosed late.

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Section: Discussionmentioning

confidence: 99%

Delayed Diagnosis of Dislocation of All Four Ulnar Carpometacarpal Joints. Surgical Treatment Strategy and Challenges.

et al. 2023

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“…11 Although divergent dislocations could occur, they are much rarer and more exceptional. 10,12 Accurate clinical diagnosis at the time of the initial visit could be difficult because it is seen in cases of acute polytrauma, with severe swelling of the hand masking the dislocated CMC joint deformity. Moreover, the overlapping of adjacent metacarpals and carpal bones may also make it difficult to observe on radiographic examination.…”

Section: Discussionmentioning

confidence: 99%

“…In acute periods, closed reduction is often successfully achieved; meanwhile, some authors recommended an open approach to guarantee anatomical reduction. 6,8,12,17 In particular, open reduction is definitely needed when there are interposed tissues to be removed 8,18 or when closed reduction is unsuccessful in patients with subacute and chronic injuries. 4,19 In our case, the dislocation did not reduce because of the interposed displaced fourth metacarpal base fragments.…”

Section: Discussionmentioning

confidence: 99%

Open Reduction for Dorsal Dislocation of Second to Fifth Carpometacarpal Joints: A Case Report

et al. 2020

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Background Fracture-dislocations of all four ulnar (second to fifth) carpometacarpal (CMC) joints are rare hand injuries and frequently overlooked or missed. These injuries can be treated conservatively when closed reduction is successfully achieved, though they are sometimes irreducible and unstable. Case Description We report the case of a 17-year-old boy involved in a vehicular accident. Clinical images showed dorsal dislocation of all four ulnar CMC joints of the left hand associated with a fracture of the base of the fourth metacarpal. Although closed reduction was attempted immediately, the affected joints remained unstable and easily redislocated. Therefore, we performed open reduction and percutaneous fixation of all ulnar CMCs. He showed excellent recovery after 1 year postoperatively, reported no pain, and demonstrated complete grip strength and range of motion of the affected wrist and fingers. Literature Review Accurate clinical diagnosis of this lesion is difficult because of polytrauma, severe swelling masking the dislocated CMC joint deformity, and overlapping of adjacent metacarpals and carpal bones on radiographic examination. As for the treatment strategy, it has yet to obtain a consensus. Some reports value open reduction to guarantee anatomical reduction, and it is definitely needed in the patients with interposed tissues to be removed or with subacute and chronic injuries. Clinical Relevance Delayed diagnosis or treatment could lead to poor outcomes. Therefore, surgeons must be aware that precise preoperative assessment is critical, and anatomical open reduction of interposed bony fragments, like our case, may be required even in an acute phase.

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“…The carpometacarpal joints are a type of plane synovial joints that provide articulation between the carpals and the metacarpals, except for the first carpometacarpal joint which is a saddle joint [ 1 ]. The dislocation of these joints of fingers is rare and accounts for less than one percent of hand injuries, with predominance of occurrence in males, as it is usually caused due to high-velocity trauma [ 2 ]. The two types of injury are volar and dorsal, which depend upon the direction of displacement.…”

Section: Introductionmentioning

confidence: 99%

Physical Therapy Management in a Severe Case of Overlapping of Bone Post Crush Injury: A Case Report

Kulkarni¹,

Wadhokar²,

Joshi³

2022

Cureus

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Crush injuries are sustained due to high velocity and usually have a poor outcome. Since the compressive forces are of high energy, such injuries are usually seen in road traffic accidents or in industrial workers. Crush injuries of the hand account for relatively a smaller percentage of the injuries to the hand and include an open wound along with fracture dislocation of the carpometacarpal, interphalangeal, and radiocarpal joints. Since these injuries are uncommon, they are often overlooked in radiological findings or misdiagnosed. Their recognition depends on a careful physical and radiographic examination that may require trispiral computed tomograms. Physical therapy rehabilitation post-surgery becomes a necessity, especially in cases where the dominant hand is affected. Functional rehabilitation to improve the independence and efficiency of activities of daily living is a goal of utmost importance.

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Divergent dislocation of the carpometacarpal joints: a case report

Cited by 5 publications

References 10 publications

Delayed Diagnosis of Dislocation of All Four Ulnar Carpometacarpal Joints. Surgical Treatment Strategy and Challenges.

Delayed Diagnosis of Dislocation of All Four Ulnar Carpometacarpal Joints. Surgical Treatment Strategy and Challenges.

Open Reduction for Dorsal Dislocation of Second to Fifth Carpometacarpal Joints: A Case Report

Physical Therapy Management in a Severe Case of Overlapping of Bone Post Crush Injury: A Case Report

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