Isolated Dorsal Dislocations of the Fourth and Fifth Carpometacarpal Joints: A Case Report and Review of Literature

Metikala, Sreenivasulu; Herickhoff, Paul

doi:10.7759/cureus.12310

Cited by 7 publications

(10 citation statements)

References 12 publications

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“…In recent years, some scholars have also reported some improved methods and achieved good results (16,17). Up to now, Which treatment strategy is more effective has been controversial (18)(19)(20)(21).…”

Section: Discussionmentioning

confidence: 99%

The long-term curative effect analysis of trans-articular plate combined with Kirschner wires in the treatment of fracture-dislocation of the fifth carpometacarpal joint

Zhou

Huang

et al. 2023

Front. Surg.

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PurposeTo evaluate the long-term curative effect analysis of trans-articular plate combined with Kirschner wires in the treatment of fracture-dislocation of the fifth carpometacarpal joint.MethodsFrom July 2016 to September 2021, 21 patients with fracture-dislocation of the fifth carpometacarpal joint were treated with trans-articular plate combined with Kirschner wires internal fixation. Each patient's gender, age, dominant hand, injured hand, trauma mechanism, the time between injury and surgery, the range of motion of the bilateral wrist in flexion, extension, radial deviation and ulnar deviation, grip strength of each side, the time of return to work, and follow-up time were recorded. The QDASH score and Cooney wrist function score were used to evaluate the postoperative function. The VAS system was used to evaluate postoperative pain.ResultsThe follow-up time was 37.0 ± 19.0 months and the time between injury and surgery was 1.3 ± 0.5 days. In the injured side and the contralateral side, the range of motion of the wrist flexion were 58.3 ± 4.0° and 60.5 ± 3.1°, the range of motion of the wrist radial deviation were 25.7 ± 3.3° and 26.9 ± 2.9°, the range of motion of the wrist ulnar deviation were 28.1 ± 3.7° and 29.5 ± 3.1° respectively with no significant difference. The range of motion of the wrist extension (54.0 ± 3.4°) in the injured side was smaller than that in the contralateral side (56.7 ± 3.7°) with significant difference. The grip strength of the injured side and the contralateral side were 96.1 ± 9.5 LB and 100.7 ± 9.7LB respectively with no significant difference. The QDASH score was 3.8 ± 1.8, Cooney wrist function score was 94.5 ± 4.2, VAS score was 1.0 ± 0.8 and the time of return to work was 5.1 ± 0.9 weeks. In the 21 cases, no postoperative complications such as incision infection, failure of internal fixation, fracture nonunion or fracture malunion occurred.ConclusionThe method of trans-articular plate combined with Kirschner wires is one of the alternative treatments for the fracture-dislocation of the fifth carpometacarpal joint. The long-term follow-up results were satisfactory.

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Section: Discussionmentioning

confidence: 99%

The long-term curative effect analysis of trans-articular plate combined with Kirschner wires in the treatment of fracture-dislocation of the fifth carpometacarpal joint

Zhou

Huang

et al. 2023

Front. Surg.

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“…3 19 On routine PA view, attention should be focused on the three carpal arcs of Gilula, the “parallel M” lines described by Fisher et al, the metacarpal cascade lines, as well as the “oblique metacarpal line” described by Chmell et al 20 Many authors focus on the crucial role of an adequate true lateral radiograph. 1 21 22 23 The articular surfaces should be parallel, with a uniform joint space, and there should be no bony overlaps. 9 20 24 25 26 27 28…”

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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“…In unstable reductions, fixation can be achieved with a K wire 7 . It can be healed by closed reduction and well molding in plaster without the need for internal fixation 3,4,6 . Also the reduction loss can be seen in the first two weeks after physical manipulation 6 .…”

Section: Discussionmentioning

confidence: 99%

“…Insufficient care of the physician in clinical examination and radiographic examinations may cause such injuries to be easily overlooked, especially in clinics with a large patient population, and this may lead to long-term pain and poor grip strength in the hand 2,3 . While stable HMC joint dislocations can be easily treated with reduction and casting, stabilizing the 5th CMC joint with various methods such as K wire in unstable injuries prevents long-term complications 4 . This case report aims to increase awareness regarding 5th CMC dislocations.…”

Section: Introductionmentioning

confidence: 99%

Isolated dorsal dislocation of the 5th carpometacarpal joint; a missed injury

AYGÜN

Yazici

2022

Journal of Emergency Medicine Case Reports

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Introduction: 5th carpometacarpal (CMC) joint dislocations of the wrist region are very rare and easily overlooked injuries. In this type of injury, which causes serious functional problems in the hand if not treated appropriately, closed methods are generally used in the treatment. In this study, we present a case with fracture-dislocation of the 5th CMC joint. Case: Fracture-dislocation of the 5th CMC joint of a 25-year-old patient who was admitted to the emergency department due to wrist pain was not noticed. The diagnosis was made during the follow-up of the patient, and the joint was reduced with closed method and fixed with a K wire. No serious problems were encountered in the patient's controls. Conclusion: Undiagnosed 5th CMC joint dislocation disrupts the transverse and longitudinal arches of the hand, so the patient has a weak and painful gripping function. Radiological findings may be unclear on anterior-posterior and lateral views, and additional images may be obtained if in doubt.

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Isolated Dorsal Dislocations of the Fourth and Fifth Carpometacarpal Joints: A Case Report and Review of Literature

Cited by 7 publications

References 12 publications

The long-term curative effect analysis of trans-articular plate combined with Kirschner wires in the treatment of fracture-dislocation of the fifth carpometacarpal joint

The long-term curative effect analysis of trans-articular plate combined with Kirschner wires in the treatment of fracture-dislocation of the fifth carpometacarpal joint

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

Isolated dorsal dislocation of the 5th carpometacarpal joint; a missed injury

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