Complex Carpal Dissociation With Open, Complete, and Divergent Trapezium, Capitate, and Hamate Dislocation: A Case Report

Perilunate and Axial Carpal Dislocations and Fracture–Dislocations

“…20,21 Similar to PLD-PLFDs, many variants of the classic types of ACDACFDs have been described. 22 The injury pattern may extend to the proximal carpal row, and axial carpal dislocations with scaphoid dislocations have been recently described. 7,20,23,24 The path of the injury is usually easy to recognize on standard x-rays, thus allowing surgical planning.…”

Total carpometacarpal joint dislocation combined with trapezium fracture, trapezoid dislocation and hamate fracture

“…The injury forces were probably transmitted axially on the radial side of the hand, and from the palmar side to the dorsum of the hand during extension, forcing all the metacarpals dorsally and causing dorsal avulsion fracture of the hamate. One case of total CMC joint dislocation was reported by Chim et al [13] together with trapezium, hamate and capitate dislocation and a transverse shaft fracture of the 5th metacarpal. Hsu et al [14] presented a case report of simultaneous dislocation of all five CMC joints, associated with fractures of the trapezium and the hook of hamate.…”

Divergent Axial Carpal Dislocation and Its Pathomechanics

“…In this case, as in the most recent cases, we can exemplify that two or more injury mechanisms have to converge. 5,11,17 In the case presented in this article, the main applied force was axial compression in association with traction and rotational forces given by the rolling press. The starting point was his fourth and fifth fingers, producing a gross dislocation advancing to the other side producing dislocation and a sagittal fracture of the trapezoid.…”

“…CT scan is recommended as part of the diagnostic protocol without delaying the initial emergency management. 1,[3][4][5]12,15 It is also mandatory to make the differential diagnosis with perilunar or isolated carpal bone dislocations. 3 In this case, due to the absence of a CT scan, the patient was undertreated in his first surgery.…”

“…The TFR in this case was avulsed in two sites, confirming the theory that no surgical carpal tunnel decompression needs to be done. 2,3,5,11,12 The ARU fracture dislocations are the type of axial injuries with more complications and worst prognosis, due to the extensile carpal involvement and soft-tissue damage. In 2013, Garcia-Elias 3 said that the injury pattern will depend on the angle formed between the applied force and the plain of the joint surface, the speed, the magnitude, the force entrance point, and the relative strength of bone and ligament structures.…”