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

Abstract

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.

Update to the difficulties in diagnostic and therapeutic management of the rare carpometacarpal joint II-V dislocation injuries: Case presentation and review of literature

“…Thus, a postoperative CT after a closed reduction procedure must be recommended by us in every instance. In the literature there are only a few case reports about persistent instability after closed reduction and it was stated that only an open reduction is able to guarantee anatomical reduction [31].…”

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

“…How to treat the fracture-dislocation of the fifth carpometacarpal joint has always been a hot topic in the field of hand surgery. At present, the commonly used surgical methods include Kirschner wire internal fixation ( 8 ), open reduction plate internal fixation ( 9 , 10 ) and external fixation ( 11 ), but all of them have shortcomings. The poor strength of Kirschner wire internal fixation can not guarantee the safety of early function exercise; the fracture of the metacarpal base is close to the carpometacarpal joint, which results in few space for proximal screws of plate internal fixation; external fixation will affect the daily life of patients after surgeries because the exposed nails might be scratched and cause pain.…”