A rare case of floating fifth metacarpal and review of literature

Abstract

Background Floating metacarpal is a rare concurrent bipolar dislocation of metacarpal at both ends. Isolated dislocations of Carpo-metacarpal (CMC) or Metacarpo-phalangeal (MCP) have been previously reported, simultaneous dislocations of both joints is scarcely reported in literature and bares high chance of diagnosis being missed on presentation. Patient A 29-year-old male presented with pain, swelling in left hand and loss of movement in fifth and fourth finger following a motorcycle fall injury. Radiography showed floating metacarpal of fifth ray along with fracture dislocation of at base of fourth metacarpal. Diagnosis The patient was diagnosed with floating fifth metacarpal along with fracture dislocation at base of fourth metacarpal. Intervention Open reduction and K-wire fixation was performed across CMC for fifth and fourth metacarpal along with MCP fixation for fifth metacarpal joint. Outcomes The patient had excellent outcome after one year with normal Range of motion and grip. Lessons Early recognition and prompt management of these injuries are considered as hallmark of prognosis. Ideal treatment for such dislocation is controversial. However, we have noted from earlier case reports that with acute dislocation and minimal swelling closed reduction and cast immobilization could be sufficient. In case of delayed presentation or swelling along with fracture, open reduction is favorable choice of treatment.

Floating proximal interphalangeal joint (PIPJ) injury of the little finger in a child: A case report

“…We report a case of fracture of neck of proximal phalanx along with fracture of base of middle phalanx of the little finger in a 15 year old child following a football injury. Though similar injuries have been reported around metacarpophalangeal joints in adults [ 1 , 2 ], we were unable to find similar injury pattern in children in published English literature. The report here is presented for its occurrence in children and the importance of the clinician in being aware of this injury.…”

The floating first metacarpal: A rare case

“…[ 1 ] It was first described by Moore et al[ 2 ] in 1978 and later named the “floating thumb metacarpal” by Drosos et al[ 3 ] Metacarpal dislocations are rare, and floating metacarpals with double dislocations are extremely rare. [ 4 ] In a recent study, there were nine case reports of floating metacarpal in the literature[ 5 ] The floating metacarpal is more often described as the thumb. [ 6 ] The treatment of these rare injuries can be quite diverse, including closed reduction and casting, percutaneous Kirschner wire (K-wire) fixation, and open repair of ligaments.…”