Isolated thumb carpometacarpal joint dislocation: a case report and review of the literature

Abstract

BackgroundIsolated thumb carpometacarpal dislocation is a rare injury pattern and the optimal treatment option is still controversial.Case DescriptionWe present a 27-year-old basketball player who underwent an isolated dorsal dislocation of the thumb carpometacarpal joint after a fall. The dislocation was successfully reduced by closed means but the joint was found to be grossly unstable. Due to inherent instability, repair of the ruptured dorsoradial ligament and joint capsule was performed.The ligament was detached from its proximal insertion into trapezium and subsequently stabilized via suture anchors. The torn capsule was repaired in an end-to-end fashion and immobilization of the joint was applied for 6 weeks.ResultsAt 3-year follow up evaluation the patient was pain free and returned to his previous level of activity. No restriction of carpometacrpal movements or residual instability was noticed. Radiographic examination showed normal joint alignment and no signs of subluxation or early osteoarthritis.ConclusionSurgical stabilization of the dorsal capsuloligamentous complex may be considered the selected treatment option in isolated carpometacarpal joint dislocations, that remain unstable after closed reduction in young and high demand patients.Level of Clinical Evidence: Level IV

Primary repair of capsuloligamentous structures of trapeziometacarpal joint: A preliminary study

“…Fotiadis et al successfully repaired the ruptured dorsoradial ligament with suture anchors and repaired the joint capsule in an end-toend fashion in one patient with 3-year follow up. 22 The patient was pain free and returned to his previous level of activity. No restriction of carpometacarpal movements or residual instability was noticed.…”

“…An unpredictable outcome of conservative or minimally invasive methods was pointed out by Fotiadis et al in his case report, switching to repair of the ruptured dorsoradial ligament with j o u r n a l o f c l i n i c a l o r t h o p a e d i c s a n d t r a u m a 5 ( 2 0 1 4 ) 1 8 5 e1 9 2 suture anchor and joint capsule with fruitful result. 22 Simonian and Trumble compared early ligamentous reconstruction with closed reduction and pinning in two groups. 10 Their data in this retrospective study suggested that early open reduction and ligamentous reconstruction results in a better outcome.…”

Pure trapezio-metacarpal dislocation - a rare injury

“…Optimal treatment strategy for traumatic Trapezio-metacarpal dislocation remains controversial. 2 Closed reduction and cast, open or closed reduction with temporary K-wire fixation, and dorsal capsule and ligament reconstruction have been used to stabilize the joint. However few cases have been reported in the literature.…”

The carpometacarpal joint of the thumb: MR appearance in asymptomatic volunteers

“…Isolated dislocation of the CMC joint is uncommon and occurs in less than 1 % of all hand injuries [6,8]. It is more often combined with a fracture of the first metacarpal base [7,9].…”

“…It is more often combined with a fracture of the first metacarpal base [7,9]. A pure dislocation of the CMC joint typically leads to a rupture of the DRL and POL [6][7][8]. Magnetic resonance (MR) imaging can be used to accurately evaluate these ligament injuries [5].…”