Carpometacarpal Joint Fracture Dislocation of Second to Fifth Finger

Abstract

BackgroundCarpometacarpal joint fracture dislocation of the second to fifth finger is a rare hand injury associated with high energy trauma. Due to severe swelling and overlapping of bones on the radiograph of wrist-hand, dislocations are missed. We reported a series of six patients with rare carpometacarpal joint fracture dislocation treated with open reduction.MethodsWe retrospectively studied six cases of carpometacarpal joint fracture dislocation. All patients were treated with open reduction and internal fixation with Kirschner wire. Functional assessment was done with Quick Disabilities of the Arm, Shoulder and Hand score (Quick DASH score) at regular intervals.ResultsAverage Quick DASH score was improved from 75.76 to 1.9 from 6 weeks to 18 months of duration. Of the six patients, three patients had a Quick DASH score of 0 at the end of 18 months.ConclusionsCareful hand examination and radiographic assessment is necessary to avoid missed diagnosis of carpometacarpal joint fracture dislocation. Early open reduction and internal fixation lead to excellent recovery of hand function.

Multiple Carpometacarpal Dislocations of the Hand – An Uncommon Variant: A Rare Case

“…5) CMC joint dislocations are often associated with concomitant carpal fractures or metacarpal base avulsion fractures due to the strong attachments of the carpometacarpal ligaments. 2,6) When these ligaments remain intact, the resultant forces produce avulsion fractures instead of dislocations. Otherwise, isolated dislocation of the carpometacarpal joint will occur.…”

A Review of the Diagnosis and Management of Index through Fifth Carpometacarpal Dislocations

“…In cases of one or two metacarpals dislocating, then an incision centred on the dislocated rays is the most practical approach to reduce these joints. When compared to palmar incisions, the dorsal incisions give sufficient visibility with less chance of inadvertent intra-operative injuries to nerves, vessels and tendons [5,41]. On the other hand, when compared with dorsal transverse incisions, the dorsal longitudinal incisions help preserve the dorsal venous network, thus making them more favourable [1,5,42].…”

“…In cases of soft tissue interposition OR not only removes these ligaments from preventing a reduction, but may offer an opportunity to repair such ligaments and tendons thus restoring stability and overall function of the hand [5]. An OR also helps with drainage of the hematoma associated with the initial injury [41]. The dorsal approach is used in most cases of an open reduction whatever the nature of the displacement of the metacarpals [1,5,42].…”

“…Some authors advocate for an OR primarily [5,41] as this aids inspection of the joint surfaces and surrounding structures as often a chondral lesion accompanies these dislocations. Debridement of chondral fragments can be carried out at the time of reduction minimising the chances of post-operative pain [42].…”

“…Debridement of chondral fragments can be carried out at the time of reduction minimising the chances of post-operative pain [42]. Through an OR, reduction of the articular surfaces under direct vision will be precise thus ensuring a congruent joint [5,41,42]. In cases of soft tissue interposition OR not only removes these ligaments from preventing a reduction, but may offer an opportunity to repair such ligaments and tendons thus restoring stability and overall function of the hand [5].…”