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Abstract
Two new cases are added to the literature on four previously reported cases of simultaneous dislocation of the five carpometacarpal joints. The priorities of management of other more extensive injuries often delays definitive treatment and in the two cases reported here open reduction and internal fixation was necessary to restore the functional structure of the hand. Restoration of normal grip and pinch strength was obtained in both patients with stable, pain-free carpometacarpal joints.
... Carpo-metacarpal dislocations of the thumbs are uncommon injuries. The first case was reported by Rivington in 1873 [1] . Treatment consists of the reduction of the dislocation then stabilization with pins in case of an unstable lesion and additional plaster cast immobilization. ...
... In the literature, CMC fractures are mainly reported as single-joint injuries and rarely as dislocations of the second to fifth CMC joints or all five CMC joints [3,4]. Furthermore, whether CMC injury is better treated with closed or open reduction or Kirschner wire or plate fixation remains controversial. ...
Background
Multiple carpometacarpal fractures and dislocations are rare. This case report describes a novel multiple carpometacarpal injury, namely, ‘diagonal’ carpometacarpal joint fracture and dislocation.
Case presentation
A 39-year-old male general worker sustained a compression injury to his right hand in the dorsiflexion position. Radiography indicated a Bennett fracture, hamate fracture, and fracture at the base of the second metacarpal. Subsequent computed tomography and intraoperative examination confirmed an injury to the first to fourth carpometacarpal joint along a diagonal line. The normal anatomy of the patient’s hand was successfully restored via open reduction combined with Kirschner wire and steel plate fixation.
Conclusion
Our findings highlight the importance of taking the injury mechanism into account to avoid a missed diagnosis and to choose the best treatment approach. This is the first case of ‘diagonal’ carpometacarpal joint fracture and dislocation to be reported in the literature.
... Rivington described the first case in 1873. [1] Carpometacarpal dislocation of the thumb is very rare, and dislocations of the 2 nd through the 5 th metacarpal accounts for about 30% of these dislocations. The diagnosis is clinically suspected and confirmed by radiology. ...
... Carpo-metacarpal dislocations of the fingers are rare. The first case was described by Rivington in 1873 [1]. Its diagnosis is clinically suspected and often confirmed on radiology. ...
Pure carpo-metacarpal dislocations are rare. Untreated, they could result in instability and early degenerative joint disease. We report the case of a 32-year-old man who suffered a closed dorsal dislocation of his third, fourth and fifth carpo-metacarpal joints. Patient underwent closed reduction dislocation by simply pulling on the axis with direct pressure on the bases of the metacarpalsand subsequent K-wire fixation. The hand was immobilized in a forearm plaster cast for 6 weeks followed by rehabilitation. At 1 year follow-up, patient had no pain and returnedto his pre-injury activity level without any discomfort.
... All the literature support that CMC dislocations are by a variety of different mechanisms which involves significant amount of force being transmitted through the metacarpals and carpals which includes high velocity trauma, crush injuries, fall from height on outstretched hand, but occur most commonly following motorbike accidents classically as a result of firmly gripping the handles prior to impact. 2 Most of the CMC joints dislocations are missed at initial examinations due to urgent attention to associated more severe injuries on other parts of body and swelling and abrasions over affected hands which makes the deformity obscure. Overlaps of bones on standard lateral X-ray may also obscure the accurate delineation of the injury pattern. ...
p class="abstract"> Background: Dislocation of carpo-metacarpal (CMC) joints especially involving the 2nd and 3rd or paired dislocations, presents a rare pattern of orthopaedics hand injuries. They are associated with high energy trauma usually involving motorbike accidents. Severe soft tissue inflammation over the affected hand and associated injuries often makes detection of these fractures difficult. They require prompt management at presentation. Failure to be diagnosed and treated at early stage leads to joint stiffness, restrictions of wrist movement, deformity and sometimes ruptures of tendons crossing the wrist. Most of them require open reduction and internal fixation for stabilization. The objective of the study was to clinically evaluate outcomes in management of carpometacarpal joint dislocations .
Methods: We prospectively studied 6 cases of CMC dislocation presenting at average of 1week from the original injury. All were clinically and radiologically evaluated. 3 cases were managed with open reduction and internal fixation with K wire and 1with closed manipulation and percutaneous k wire fixation and 1 case by arthrodesis of CMC joint. Functional assessment was done with Quick DASH score at 6 weeks, 3 months, 6 months and 1 year.
Results: All the patients went on to have good functional recovery. The average quick DASH score showed improvement from 77.39 to 4.07 over 1 year follow-up .
Conclusions: Careful and meticulous examinations of hands are necessary in high velocity trauma cases to avoid missing diagnosis of CMC dislocation. ORIF remains the gold standard treatment which can also be used for cases presenting late, followed by aggressive post-op physiotherapy can lead to excellent recovery of hand function . </p
... Les luxations carpo-métacarpiennes des doigts sont des lésions rares. Le premier cas a été décrit par Rivington en 1873 [1]. Le diagnostic est suspecté cliniquement et confirmé par la radiologie. ...
Les luxations carpo-métacarpiennes sont des lésions rares, les auteurs rapportent un cas de luxation carpo-métacarpienne palmaire du cinquième doigt, traité en urgence par réduction et stabilisation par embrochage à foyer fermé. Une immobilisation postopératoire par une attelle intrinsèque plus a été réalisée pendant six semaines, avec une rééducation à partir de la quatrième semaine. Le résultat fonctionnel était satisfaisant.
Traumatic carpo-metacarpal dislocations without associated fractures are rare, and the palmar variant is particularly exceptional. If left untreated, these injuries can lead to instability and premature joint degeneration. We report the case of a palmar carpo-metacarpal dislocation of the fourth metacarpal in a 42-year-old woman. Upon clinical examination, the patient presented with a 10-degree rotational deformity and limited adduction (radial inclination). Imaging revealed a diastasis between the bases of the fourth and fifth metacarpals, along with a palmar dislocation of the base of the fourth metacarpal. Treatment consisted of a closed reduction, stabilized with pinning, followed by joint immobilization for 6 weeks. After a 15 months follow-up, the patient was pain-free and had resumed all activities without any discomfort.
Les luxations carpo-métacarpiennes des doigts sont des lésions rares. Le diagnostic est suspecté cliniquement et confirmé par la radiologie. Le traitement consiste à faire une réduction en urgence, une stabilisation en cas de lésion instable et une immobilisation plâtrée complémentaire.
Nous rapportons l’expérience de 3 cas de luxation carpo-métacarpienne palmaire du cinquième doigt associé ou non à des fractures ou luxation d’autre rayons, traité en urgence par réduction et stabilisation par embrochage à foyer fermé. Une immobilisation postopératoire par une attelle intrinsèque plus a été réalisée pendant six semaines, avec une rééducation à partir de la quatrième semaine. Nos résultats ont été confrontés aux résultats de la littérature.
Les luxations carpo-métacarpiennes des doigts longs sont des lésions rares, souvent associées à des fractures du carpe ou des os de la main. Un grand nombre passe inaperçues soit à cause d'un examen sommaire mal fait ou rentrant dans le cadre d'un polytraumatisme. Sous réserve d'un traitement urgent et correct, elles sont de bon pronostic .
Introducción: Las luxaciones carpo-metacarpianas son lesiones poco frecuentes, que van del 0.5 al 1% de las luxaciones de los huesos de la mano. Siendo extremadamente infrecuente la luxación simultanea de los 5 dedos.
Objetivo: El objetivo de nuestro trabajo es documentar una lesión poco frecuente producida en un paciente asistido en nuestro centro. Así como realizar una puesta a punto sobre las medidas diagnósticas y terapéuticas de dicha lesión.
Caso clínico: Se presenta el caso de un hombre de 63 años, diestro, artesano en hierro y madera, que sufre un accidente de tránsito de alta energía en moto versus auto, sufriendo traumatismo en mano derecha, sin presentar otros traumatismos. De la exploración física, en el departamento de emergencia, se constata la mano derecha dolorida con gran deformidad en dorso. Se diagnosticó: luxación dorsal carpo-metacarpiano de los 5 metacarpianos, con fractura del sector distal del trapecio, trapezoide, hueso grande y ganchoso. Se realizó reducción cerrada en block quirúrgico con anestesia general, siendo la reducción inestable se colocan agujas de Kirschner para su estabilización. Se confecciona, además, una férula de yeso de protección. Se solicitó una tomografía computada de control donde se objetiva buena reducción de las 5 articulaciones carpo-metacarpianas. Se retiraron las agujas de Kirschner a las 6 semanas. A los 3 meses de la lesión presenta una mano indolora, con buen rango de movilidad, con disminución a la fuerza prensil máxima comparada con la contralateral. El paciente reanuda sus tareas, incorporándose totalmente al trabajo a los 6 meses. Presenta, al año de la cirugía, un score de DASH excelente.
Discusión: Las luxaciones de los 5 metacarpianos son lesiones extremadamente raras. Se han reportado en el mundo menos de 20 casos. A pesar de los elementos clínicos sugestivos, el diagnostico de esta lesión es difícil, siendo fundamental contar con un enfoque radiológico de perfil estricto de mano. Los resultados de esta lesión son inciertos, la función de la mano y la muñeca se mantiene pero frecuentemente asociado a una reducción de fuerza prensil. Este tipo de trauma lleva, en mayor o menor grado, al desarrollo de artrosis carpo metacarpiana a largo plazo.
L es articulations carpo-metacarpiennes (CMC) des doigts longs n'ont jamais beneficie du meme niveau d'interet que leur homologue au niveau du pouce. Elles meritent pourtant une attention particuliere car leur similitude avec l'articulation trapezo-metacarpienne (TM) se borne a une simple position anatomique au niveau de la main. Les differences sont importantes, en particulier lesionnelles, car si la fracture est plus frequente pour la premiere colonne (fracture de Bennett et de Rolando), c'est la luxation qui predomine pour les quatre derniers rayons. Les differences sont aussi anatomiques, car a la mobilite et a la position detachee et isolee du pouce par rapport aux doigts longs, s'oppose un bloc carpo-metacarpien extremement compact et quasiment fixe.
The increasing number of industrial accidents, especially when security measures are not strict, renders rare axial injuries more frequent. In this type of injuries, the wrist is being divided into two or more columns with the respective metacarpals. Among fracture dislocations of the wrist, axial dislocations are more frequently associated with soft tissue damage, which is the main determining factor for the outcome; on the other hand, the functional results of the hand are usually unpredictable. The biomechanics of the transverse plane of the distal carpal row, as well as the incidence, the mechanism of injury and the clinical presentation of this rare type of injuries are also examined. In addition, these injuries result in mainly three types of axial dislocations, but the high-energy nature of the injuries could also produce unusual patterns of carpal derangement, which renders them difficult to classify. The management, outcome and complications of axial dislocations are also studied in this chapter.
Multiple carpometacarpal (CMC) joint dislocations are rare. These clinical entities require significant amount of force to produce dislocation at this inherently stable joint level. We present a case of unstable dorsal dislocation of ulnar four carpometacarpal joints without associated fractures which was fixed with multiple K-wires with good functional outcome. Although carpometacarpal dislocations are uncommon entities, the case is reported here not just by virtue of its rarity but also because of a tendency for such injuries to be overlooked by surgeons with resultant delay in diagnosis and treatment.
Objectives: The first total hip replacement (THR) in Nigeria was performed in 1974. But due to infrastructural decay in public institutions, arthroplasty outcome was poor. National Orthopedic Hospital, Enugu (NOHE) - a regional trauma and orthopedic centre took the initiative in 2008. This paper presents our preliminary results and lists our challenges in establishing this service in a resource- constrained economy. Design: Prospective Setting: NOHE, Nigeria Subjects: Fifty-two patients who had primary hip arthroplasty between November 2008 and November 2010. Method: Details of demographic data, joints affected, etiology, co-morbidities, anesthesia, postoperative treatment, complications, and follow-up were recorded, analyzed and challenges noted Intervention: Total hip replacement. Main Outcome Measures: Improvement in patient's function and re-operation rate Result: Fifty-four THRs were done in fifty-two patients. Twenty nine (53.7%) patients were male. The mean age was 52 ± 2.4 years. Two patients had staged bilateral hip replacement. Twenty five (48.1%) patients had primary osteoarthritis. The commonest complaint at presentation was incapacitating hip pain. Half of the patients 26 (49.9%) had this pain for over four year. Trauma related secondary arthritis was responsible for 21 cases and old unreduced hip dislocation in five (9.6%) patients. Six patients had previous hip surgeries. Implant dislocation occurred in three (5.5%) patients. The functional status improved in all patients as shown by Harris Hip scores. Conclusion: There is an absolute need to develop arthroplasty service in Nigeria. A good number of the cases were complex primary arthroplasties. Most of the patients were relatively young and will outlive their implant.
Pure carpo-metacarpal dislocations without any fracture are rare, their volar component is exceptional. Untreated injuries can result in instability and early articular degeneration. We report a 72-year-old female patient who underwent an isolated closed volar dislocation of her fifth finger carpo-metacarpal joint after a fall. The clinical examination showed a 10°-defect in rotation with limited adduction (radial deviation). The X-rays showed a gap between the base of the fourth and the fifth metacarpal bones with volar dislocation of the base of the fifth carpometacarpal joint. The dislocation was successfully treated by closed reduction maintained with two K-wires. Immobilisation of the joint was applied for 6 weeks. At 2 years follow-up evaluation, the patient was pain free with no clinico-radiological evidence of instability and had returned to her previous level of activity.
Pure carpo-metacarpal dislocations without any fracture are rare, their volar component is exceptional. Untreated injuries can result in instability and early articular degeneration. We report a 72-year-old female patient who underwent an isolated closed volar dislocation of her fifth finger carpo-metacarpal joint after a fall. The clinical examination showed a 10°-defect in rotation with limited adduction (radial deviation). The X-rays showed a gap between the base of the fourth and the fifth metacarpal bones with volar dislocation of the base of the fifth carpometacarpal joint. The dislocation was successfully treated by closed reduction maintained with two K-wires. Immobilisation of the joint was applied for 6 weeks. At 2 years follow-up evaluation, the patient was pain free with no clinico-radiological evidence of instability and had returned to her previous level of activity.
Copyright © 2014 Elsevier Masson SAS. All rights reserved.
The carpometacarpal dislocations are rare injuries. The authors report an unusual case of dorsal carpometacarpal joint dislocations of the ulnar two fingers, treated by closed reduction and fixation with percutaneous Kirschner-wires. A plaster splint with the wrist in neutral position was applied for six weeks. Active physiotherapy of the fingers was started from four weeks after surgery, with a satisfactory result.
Anterior carpometacarpal dislocation are rare injuries. The anterior type is exceptional. Mr A.T 18 years old, male, student, right-handed, without pathological medical history. He was admitted in emergency after a fall of a motorbike (unknown mechanism) for a closed left hand injury; examination revealed a total impaired mobility and an important swelling of the hand without vasculonervous disorders. X-ray revealed a pure anterior dislocation of the five carpometacarpal joints. The patient was operated on in emergency using both anterior and posterior approach, which allowed to reduce the dislocation. It was maintained by K-wires. An antebrachiopalmar cast was applied for six weeks. One year later, the result obtained was considered excellent.
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Dislocation of the multiple carpometacarpal joints without associated fractures of the metacarpal and/or carpal bones is an exceedingly rare injury. An earlier belief that carpometacarpal dislocations are high-energy injuries is questioned due to an unusual case of isolated dislocation of the four ulnar metacarpals that occurred after a relatively minor hand trauma. Early recognition and anatomical reduction are essential to achieving good long-term outcomes. Massive edema, interposed volar ligaments and overlapping metacarpal bases are the usual obstacles to a successful closed reduction.
This paper reports a farm accident by an animal causing an extremely rare divergent dislocation of the four carpometacarpal joints.
A case of simultaneous dislocations of the carpometacarpal joints is reported. Closed reduction and splinting produced a good result.
Two new cases are added to the literature on four previously reported cases of simultaneous dislocation of the five carpometacarpal joints. The priorities of management of other more extensive injuries often delays definitive treatment and in the two cases reported here open reduction and internal fixation was necessary to restore the functional structure of the hand. Restoration of normal grip and pinch strength was obtained in both patients with stable, pain-free carpometacarpal joints.
Dislocation of the carpometacarpai joints other than that of the thumb is a rare injury. To the best of our knowledge, no case of simultaneous closed volar dislocation of four carpometacarpal joints has so far been reported in the literature (Hazlett, 1968; Henderson and Arafa, 1987). We present such a case and also suggest a mechanism of injury. Case report A 24year-old man presented to the emergency services following a motorcycle accident. Clinical examination showed a markedly swollen hand held in neutral position. Abrasions were present on the dorsum of the hand close to the knuckles. There was no neurovascular deficit. Radiographs revealed a volar dislocation of the medial four carpometacarpal joints, without any associated fractures. A stable reduction was achieved by closed manipulation. A below-elbow volar plaster slab was given for 4 weeks. Serial check radiographs confirmed the maintenance of reduction. The plaster was removed after 4 weeks and the hand was mobilized. Finger movements and grip strength returned to normal 7 weeks from the date of injury. Figures 1-4 illustrate the case.
The authors report a case of combined dorsal fracture-dislocations of all 4 fingers, palmar trapezo-metacarpal dislocation and metacarpophalangeal dislocation of the thumb following a motorbike accident. These exceptional lesions were treated as an emergency by reduction and pinning. With a follow-up of 13 years, the patient still worked as an electrician.
Simultaneous dislocation of the five carpometacarpal joints
- Resnick
Compound dislocation of all the metacarpal bones of the right hand: operation, recovery with a serviceable hand
- S Rivington