Divergent fracture-dislocation of the second carpometacarpal joint and the three ulnar carpometacarpal joints

doi:10.1053/jhsu.2001.20153

The Journal of Hand Surgery

Volume 26, Issue 1, January 2001, Pages 123-129

https://doi.org/10.1053/jhsu.2001.20153 Get rights and content

Abstract

A case of divergent dislocation between the second metacarpal and the three ulnar metacarpals is presented. Severe edema, fragments of the trapezoid, and interposed volar ligaments prevented successful closed reduction. Open reduction enabled restoration of the carpometacarpal complex with excellent recovery of hand function. (J Hand Surg 2001;26A:123-129. Copyright © 2001 by the American Society for Surgery of the Hand.)

Section snippets

Case report

A 25-year-old student fell off a speeding scooter after a collision. He presented in the emergency department with pain in the right hip, right foot, and left hand. The vital signs were stable. He had tenderness on trochanteric compression and massive swelling of the right foot and left hand. No distal neurovascular deficit was recorded in the injured extremities. The anteroposterior x-ray view of the wrist showed abnormal overlapping of the articular surfaces of the affected carpometacarpal

Discussion

Disruption between the second and third rays is a high-energy injury analogous with the divergent Lisfranc's fracture-dislocation of the foot. The interlocking osseous architecture of the index and middle finger carpometacarpal joints, which is supported by thick ligaments, makes this an extremely stable complex.2, 4 The carpometacarpal joints of the ring and little fingers have a saddle configuration with looser ligamentous attachments, permitting greater mobility.² The bases of the 4 ulnar

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Cited by (37)

Multiple carpometacarpal joint fracture-dislocation from the second to fifth: A case report
2022, Annals of Medicine and Surgery
and importance: Herein we present a rare case of multiple second to fifth carpometacarpal joint fracture-dislocations. It is important in such cases to be aware of a high-velocity impact etiology of the fractures, which will ensure proper imaging, diagnosis and treatment.
A 34-year-old male presented with severe pain in his left hand following a motorcycle accident. He was diagnosed as multiple second to fifth carpometacarpal joint fracture-dislocations. He was successfully treated with closed reduction with multiple Kirshner wires fixation under general anesthesia. A one-year follow up confirmed excellent clinical results.
There are various surgical options including casting, closed reduction and percutaneous pinning (CRPP), and open reduction internal fixation, however, the optimal treatment is still controversial. The closed reduction is recommended in all CMC joint dislocations. Adding a K-wire fixation can create a secure fixation and achieve an excellent outcome.
Multiple carpometacarpal joint fracture-dislocations is a very rare injury. Careful clinical examination is important for an accurate diagnosis and plain radiographic studies are necessary. Standard fracture dislocation treatment can be used. Simple closed reduction with the K-wires fixation technique is easy to perform and in our case achieved successful treatment in terms of clinical and radiographic outcomes.
Pure divergent dislocation of the index and middle finger carpometacarpal joints: A rare case
2019, Trauma Case Reports
Citation Excerpt :
At two months follow-up, results were excellent and patient has recovered all of his range of motion and hand activities, after one-year follow-up clinical and radiological control showed no recurrence of CMC instability (Fig. 4) nor reduced strength of the hand, no chronic pain and no signs of osteoarthritis of CMC joints were observed, he was able to perform all military exercises such as pumping and climbing (Fig. 5). Divergent carpometacarpal dislocations between two metacarpals are very rare orthopedic injuries with only four reported cases, described first by Hartwig in 1979, Gunther in 1985, Busa in 1998 and Dillon in 2005 [1–5]. But pure divergent dislocation involving the second and third CMC was never reported to our knowledge, because of their strong stabilizers provided by dorsal, volar and transverse metacarpal ligaments and long flexors and extensors of hand along with the intrinsic muscles and geometry of the articular surfaces of CMC joints.
A pure divergent dislocation involving the index and middle finger carpometacarpal joints is an extremely rare injury. We present a case of 21-year-old military man, victim of a motor vehicle accident, admitted at the emergency department unable to move his left hand with major swelling. X-rays and CT scan showed a dorsal dislocation of second and palmar dislocation of the third carpometacarpal joints without associated fracture, In the Operating room under general anesthesia, patient underwent closed reduction and internal fixation with percutaneous K-Wires followed by cast immobilization during 6 weeks. Physiotherapy was started progressively after k-wires removal. At two months follow-up, results were excellent and patient has recovered all of his range of motion and hand activities, at one-year follow-up he was able to perform all military exercises such as pumping and climbing.
Fourth and fifth carpometacarpal fracture-dislocations is plate or Kirschner wire fixation superior: A retrospective cohort study
2018, International Journal of Surgery
Fourth and fifth carpometacarpal fracture-dislocations with unsatisfactory closed reduction commonly require later open reduction and internal fixation. However, the optimal method of internal fixation for these is unknown. The purpose of this study was to determine through objective clinical measures which method is superior for fourth and fifth carpometacarpal fracture-dislocations: a K-wire or a plate.
We conducted a retrospective review of hospital records of patients who had received treatment for fourth and fifth carpometacarpal fracture-dislocations at one hospital between May 2007 and May 2015. A total of 86 patients who had received open reduction either with plate or K-wire fixation were included. Demographic and clinical characteristics of the two groups of patients were collected. Patients received standardised clinical tests one year after fixation. Clinical outcomes included tests of grip strength and scores on the Michigan Hand Outcomes Questionnaire and Disabilities of Arm, Shoulder, and Hand. Student's t tests and Chi-square tests were used to statistically evaluate whether plate or K-wire fixation was superior on the clinical variables.
The two groups were statistically indistinguishable on their demographic and clinical characteristics. Generally, the clinical outcomes of internal fixation were satisfactory. The average DASH and MHQ scores of the K-wire group were superior to those of the plate group (DASH 2.3 versus 9.8, P = 0.01; MHQ 96.7 versus 86.6, P = 0.02). Grip strength was not significantly different between the two groups (89.5 ± 5.8% versus 90.1 ± 4.9%, P = 0.36).
This non-randomly controlled, retrospective study suggests that clinical outcomes after K-wire fixation is superior to plate fixation for fourth and fifth carpometacarpal fracture-dislocations. This is especially the case for hand functions related to work. The present results suggest that K-wire fixation is the gold-standard technique for the treatment of fourth and fifth CMC fracture-dislocations.
Carpo-metacarpal irreducible dislocations of the long fingers. Case report with literature review
2014, Journal de Traumatologie du Sport
Nous rapportons un cas de luxations multiples des articulations carpo-métacarpiennes des doigts longs survenues après un traumatisme fermé de la main droite lors d’un match de volley-ball. Il s’agit de luxations dorsales carpo-métacarpiennes des doigts longs (pouce exclu), sans aucune fracture associée. Nous les avons traitées par une réduction à foyer ouvert, après échec du traitement orthopédique puis stabilisation par embrochage suivie d’une immobilisation de 4 semaines. La rééducation a été débutée précocement et poursuivie plusieurs semaines après ablation des broches. Au dernier recul de 8 mois, le résultat fonctionnel était satisfaisant, avec une bonne force musculaire et une récupération complète de la mobilité du poignet, des doigts en flexion-extension. Le patient a pu reprendre ses activités quotidiennes et sportives. La difficulté du diagnostic, le mécanisme de survenue ainsi que le traitement sont discutés.
We report a case of traumatic multiple dislocations of the carpo-metacarpal joints without dislocation of the first metacarpal base joint during a volleyball game. This injury is uncommon and has been reported rarely. We performed open reduction and wire fixation after failure of the orthopedic treatment. At 8 months follow-up, the functional outcome was satisfactory with good muscle strength and good range of motion was preserved. The patient has been able to return to all his daily and sports activities. The difficulty of diagnosis, mechanism of the injury and treatment are discussed.
Multiple volar dislocations of the carpometacarpal joints with an associated fracture of the first metacarpal base
2014, Chinese Journal of Traumatology - English Edition
Multiple volar dislocations of carpometacarpal (CMC) joints are uncommon and have been reported rarely. A 25 years old male presented with injury to his left hand 6 days following a road traffic accident. Clinical examination revealed gross swelling of the hand and diffuse tenderness over the carpometacarpal area. His radiographs of the hand showed volar dislocation of the second third and fourth CMC joints in association with an extra-articular fracture of the base of thumb metacarpal. He was treated by open reduction and percutaneous fixation using Kirschner wires. The functional results were excellent at one year follow-up
Acute carpometacarpal joint dislocation of long fingers. Study about 100 cases
2011, Chirurgie de la Main
Les auteurs analysent les résultats cliniques et radiologiques des luxations carpométacarpiennes (LCMC), prises en charge en urgence entre 2002 et 2009. Ils précisent les mécanismes de survenue et les pièges du diagnostic, et discutent les choix thérapeutiques.
Une étude rétrospective a été menée sur 100 dossiers. Le mécanisme lésionnel était un coup de poing dans 56 % des cas. La lésion concernait uniquement le cinquième rayon dans 51 % des cas. Il existait des fractures associées dans 88 % des cas. Tous les patients ont été traités chirurgicalement soit par brochage percutané (60 %), soit par stabilisation à ciel ouvert (40 %). Le recul moyen était de cinq mois. Les critères recherchés sur les dernières radiographies étaient la réduction anatomique des luxations, la consolidation et la réduction des fractures. L’évaluation clinique portait sur la douleur, l’enroulement des doigts et la force subjective.
Les radiographies étaient satisfaisantes dans 68 % des cas. Les résultats imparfaits (subluxation résiduelle, fracture incomplètement réduite), étaient deux fois plus importants lorsque le traitement avait été réalisé en percutané. À la dernière consultation, 81 % des patients ne présentaient aucune douleur et avaient un enroulement complet des doigts. Seize pour cent gardaient une douleur au serrage de la poigne.
Les LCMC ne sont pas aussi rares que le suggère la littérature. La précocité du diagnostic et le traitement en urgence sont des éléments essentiels du pronostic. Les indications de scanner doivent être élargies pour dépister l’ensemble des lésions. La réduction à ciel ouvert, en permettant le traitement de toutes les fractures associées, doit être privilégiée.
The authors report clinical and radiological results of carpometacarpal dislocations treated in emergency over a period of 7 years (2002–2009). Mechanisms of injury and diagnosis pitfalls are specified, and treatment options are discussed.
A retrospective study of 100 carpometacarpal dislocations was performed. Most commonly trauma was a punch (56%). In half the cases, lesions were located only within the fifth ray. Carpal or metacarpal fractures were associated in a majority of cases (88%). Surgical treatment was carried out in all cases either by closed reduction and percutaneous pinning (60%), or by open reduction and internal fixation (40%). The mean follow-up was 5 months. Anatomic reduction of dislocation, consolidation and reduction of associated fractures were analysed on the last follow-up x-rays. Evaluation tools were pain score, range of motion and grip strength.
Radiological criteria were satisfactory in 68% of cases. Non-satisfactory X ray criteria were mainly associated with closed reduction and percutaneous pinning. At final follow up, 81% of the patients were pain-free and had recovered complete range of motion. In 16% of patients pain was only found during grip strength test.
Carpometacarpal luxations are not as rare as suggested by literature. Early diagnosis and treatment are essential for the prognosis. Increasing indications of a scan enable better analysis by identifying all injuries. Open reduction by which allows the treatment of all associated injuries must be promoted.

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^*: No benefits in any form have been received or will be received from a commercial party related directly or indirectly to the subject of this article.

^**: Reprint requests: Rajesh Malhotra, MS, Department of Orthopedics, All India Institute of Medical Sciences, Ansari Nagar, New Delhi—110029, India.

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Original CommunicationsDivergent fracture-dislocation of the second carpometacarpal joint and the three ulnar carpometacarpal joints*,**

Abstract

Section snippets

Case report

Discussion

Orthop Clin North Am

Hand Clin

J Hand Surg

J Hand Surg

J Hand Surg

J Hand Surg

Hand Clin

J Hand Surg

Original Communications
Divergent fracture-dislocation of the second carpometacarpal joint and the three ulnar carpometacarpal joints*,**