Volar Dislocation of Second, Third and Fourth Carpometacarpal Joints in Association with a Bennet's Fracture of the Thumb Carpo-Metacarpal Dislocation: A Case Report

Abstract

Injuries of the carpometacarpal joints of the long fingers are infrequent and go often unnoticed if a thorough clinical exploration and complete radiological assessment is not carried out. The overall frequency of carpometacarpal joints injuries is of 1-2% among trauma of the wrist and the carpus. These are normally secondary to high energy trauma (such as a car or a motorbike accidents). Among these kinds of injuries, the volar dislocation of the metacarpals is much less frequent than the dorsal dislocation, being even rarer the cases in which the three middle metacarpals are involved.In this case report, we present a case of volar dislocation of the middle three carpometacarpal joints in association with a Bennet’s fracture of the thumb in a 30-year-old male. He was treated in the operating room with reduction and stabilization using Kirschner wires, which allowed a satisfactory recovery of the mobility of the fingers eight weeks after the intervention. It is important to produce an admission diagnosis of this kind of injuries to be able to treat them immediately. Treatment must be performed quickly to reduce and stabilize the dislocation, since this will avoid the vasculo-nervous compression or the edema which increases cutaneous suffering and the risk of complications.

Dorsal approach for isolated volar fracture-dislocation of the base of the second metacarpal: A case report

“…Although several reports have described dislocation of the carpometacarpal (CMC) joints, volar dislocation has been rarely reported[ 1 - 6 ]. Dislocations of the CMC joints of the second and third metacarpals are extremely rare because of the strong ligamentous attachments and stable bony structures[ 7 - 13 ].…”

Volar radial Carpometacarpal dislocation of the fourth and fifth fingers

“…Carpometacarpal joint injuries have an overall frequency of 1-2% among trauma of the wrist and the carpus [1]. Carpometacarpal joints are particularly stable, as the intermetacarpal, carpo-metacarpal and carpo-metacarpal ligaments converge at the base of the metacarpal.…”

“…Only very violent trauma can cause carpo-metacarpal dislocation [2]. Among these kinds of injuries, the volar dislocation of the metacarpals is much less frequent than the dorsal dislocation [1]. Those of the fourth and fifth metacarpals are more frequent than those of the second and third metacarpals due to the higher range of mobility of the former.…”

The various patterns of dislocation injuries at the carpometacarpal joints: A case series and brief review of literature with regards to the main topics

“…Simultaneous dislocation injuries of the CMCJs II-V in volar direction, first reported by Tricksen in 1872, are very uncommon and can be initially associated with an acute compression syndrome of the median and/or ulnar nerve. Depending on the integrity of the flexor carpi ulnaris tendon and/or the pisometacarpal ligament, dislocation injuries of the CMCJ V can be further subclassified as radial or ulnar [3,4,[12][13][14][15][16][17][18].…”

“…Primary conservative treatment (i.e. closed reduction without pinning) can be an option if stability of joints can be safely assessed [3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18].…”