Dislocation of ulnar side all four carpometacarpal joints – a case report

Shah, Ram Kewal; Ranjan, Abhisek; Shah, Niraj Kumar

doi:10.1080/23320885.2021.1910039

Cited by 1 publication

(5 citation statements)

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“…The incidence of CMC joint injuries is estimated between 0.2 and 1% of all hand injuries, while dislocation of all four ulnar metacarpals is rarer. 1 2 3 4 To our knowledge, the presented case is the first report in literature of an all four ulnar CMC joint dislocation that was diagnosed and treated in such a chronic setting.…”

Section: Discussionmentioning

confidence: 79%

“…3 19 On routine PA view, attention should be focused on the three carpal arcs of Gilula, the “parallel M” lines described by Fisher et al, the metacarpal cascade lines, as well as the “oblique metacarpal line” described by Chmell et al 20 Many authors focus on the crucial role of an adequate true lateral radiograph. 1 21 22 23 The articular surfaces should be parallel, with a uniform joint space, and there should be no bony overlaps. 9 20 24 25 26 27 28…”

Section: Discussionmentioning

confidence: 99%

“…lines described by Fisher et al, the metacarpal cascade lines, as well as the "oblique metacarpal line" described by Chmell et al 20 Many authors focus on the crucial role of an adequate true lateral radiograph. 1,[21][22][23] The articular surfaces should be parallel, with a uniform joint space, and there should be no bony overlaps. 9,20,[24][25][26][27][28] In recent years, the role of a thin slice CT scan has been pointed out, as it can confirm the diagnosis in difficult cases, provide a better assessment of the joint surfaces and concomitant fractures, and help in the preoperative planning.…”

Section: Discussionmentioning

confidence: 99%

“…Our radiological workup (X-rays, a thin slices computed tomography [CT] scan of the hand) revealed a dorsal CMC dislocation of all four ulnar metacarpals, along with a fracture of the base of the fifth metacarpal (►Figs. [1][2][3]. A closed reduction was attempted at first but was unsuccessful, possibly due to the callus formed on the fracture site and the stiffness of the hand.…”

Section: Case Presentationmentioning

confidence: 99%

“…

Carpometacarpal (CMC) dislocations are rare injuries whose diagnosis is often missed on initial presentation (< 1% of all hand injuries). [1][2][3] They are usually the result of a high-energy mechanism of injury like direct punching, falls from a height, motorcycle and car crashes, and vehicle-pedestrian collisions. Unfortunately, the diagnosis of these injuries is often omitted or delayed.

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mentioning

confidence: 99%

See 4 more Smart Citations

Delayed Diagnosis of Dislocation of All Four Ulnar Carpometacarpal Joints. Surgical Treatment Strategy and Challenges.

et al. 2023

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Background Carpometacarpal dislocations are rare injuries whose diagnosis is often missed initially. These injuries can be treated conservatively, as long as an anatomical closed reduction is achieved. However, in most cases, open reduction followed by internal or external fixation is necessary to reach a stable anatomical reduction. Case Description A 32-year-old male was referred to our institution due to excess swelling of his right hand, 2 months after a motorcycle crash he sustained. During our imaging workup, a dorsal carpometacarpal dislocation of all four ulnar metacarpals was found accompanied by a fracture of the base of the fifth metacarpal. An open reduction was achieved using Kirschner wires and a small plate for arthrodesis of the fifth carpometacarpal joint. The postoperative follow-up on the 3rd, 6th, and 12th month was uncomplicated. The range of motion and grip strength was satisfactory on the 3rd month and almost full on the 6th month compared to the unaffected side. Literature Review Carpometacarpal dislocations are rare hand injuries. They are often the result of a high-energy injury and their diagnosis is usually delayed or missed. The main reasons are the excessive pain and swelling of the hand which make the initial clinical examination difficult and the overlapping of the metacarpals on the X-ray, which make the radiological diagnosis challenging. Case Relevance A delayed diagnosis needs urgent open surgical treatment to achieve an anatomical reduction due to the interposition of soft tissue, bony fragments, and newly formed callus. Diagnosis and treatment of these injuries demands a high clinical suspicion from the traumatologist. The role of computed tomography scan is invaluable and open reduction is the mainstay of treatment for the cases that are diagnosed late.

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Section: Discussionmentioning

confidence: 79%