medigraphic.com
ISSN 2007-8560 (Print)
Órgano Oficial de Difusión Científica de la Federación Mexicana de Colegios de Ortopedia y Traumatología, A.C. (FEMECOT)

2023, Number 3

<< Back

Ortho-tips 2023; 19 (3)

Isolated dorsal dislocation of the carpometacarpal joint: a case report

Campos PD, Villalobos CC

Language: Spanish
References: 25
Page: 182-192
PDF size: 450.71 Kb.


ABSTRACT

Introduction: pure dislocation of the carpometacarpal joint is a rare injury. There are few national publications that cover this condition. It occurs secondary to high-energy injuries. Pure dorsal dislocations occur more frequently and mainly affect the fourth and fifth metacarpals. They are often overlooked in emergency care, so they progress to the chronic stage, and are initially considered a high index of suspicion by the doctor. Objective: we present a case of late diagnosis of isolated dorsal dislocation of the fourth and fifth carpometacarpal joints that was managed surgically and review the existing literature for the diagnosis, treatment and prognosis of this rare pathology. Clinical case: a 22-year-old male with a history of direct contusion on the left wrist, which causes severe pain, increased volume, functional limitation, treated with non-steroidal anti-inflammatory drugs (NSAIDs) for four weeks without improvement. Radiographically without data of continuity solution, but with loss of joint congruence of the base of the fourth and fifth metacarpals. Diagnosing an isolated chronic dislocation of the fourth and fifth metacarpals of the left hand. Dorsal hand approach and open reduction with stabilization by placing two 1.6 mm retrograde Kirschner pins, immobilization with antebrachipalmar splint for 6 weeks and physical rehabilitation is performed. At the end of the therapeutic process, full range of motion, without visible sequelae to mobilization. Conclusions: it is important to perform a complete examination of the hand and confirm radiographically to avoid missing the diagnosis. Most dislocations present joint instability and it continues to be the determining parameter for surgical intervention. The treatment of choice continues to be open reduction and internal fixation, which allows excellent recovery of hand function.


REFERENCES

  1. Ayala GU. Luxación dorsal de la articulación carpometacarpiana: informe de tres casos. An Med Asoc Med Hosp ABC. 2012; 57 (2): 144-148. Disponible en: https://www.medigraphic.com/cgi-bin/new/publicaciones.cgi?IDREVISTA=11 https://www.medigraphic.com/pdfs/abc/bc-2012/bc122j.pdf

  2. Desai B, Nammour M, Warren M, Sumarriva G, Sisco-Wise L. Isolated volar dislocation of the fifth carpometacarpal joint. Ochsner J. 2020; 20 (2): 215-218. doi: 10.31486/toj.18.0151. Available in: https://pubmed.ncbi.nlm.nih.gov/32612479/.

  3. Pundkare GT, Patil AM. Carpometacarpal joint fracture dislocation of second to fifth finger. Clin Orthop Surg. 2015; 7 (4): 430. doi: 10.4055/cios.2015.7.4.430.

  4. Domingo A, Font L, Saz L, Arandes JM. Isolated radial palmar dislocation of the fifth carpometacarpal joint with ulnar neuropathy associated: successful treatment with closed reduction and internal fixation. European Journal of Orthopaedic Surgery & Traumatology. 2008; 19 (2): 101-107. Available in: https://doi.org/10.1007/s00590-008-0377-7

  5. Anjum R, Roy A, Farooque K, Sharma V. An isolated pure dislocation of fifth carpometacarpal joint: case report and review of literature. J Orthop Case Rep. 2017; 7 (2): 14-16. doi: 10.13107/jocr.2250-0685.728.

  6. Beekhuizen S, de Witte PB, Rutgers M, Ohanis D. Isolated ulnopalmar dislocation of the fifth carpometacarpal joint. BMJ Case Rep. 2018; bcr-2018-225363. doi: 10.1136/bcr-2018-225363. Available in: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5950705/

  7. Berg EE, Murphy DF. Ulnopalmar dislocation of the fifth carpometacarpal joint-Successful closed reduction: review of the literature and anatomic reevaluation. J Hand Surg Am. 1986; 11 (4): 521-525. doi: https://doi.org/10.1016/S0363-5023(86)80189-7. Available in: https://www.jhandsurg.org/article/S0363-5023(86)80189-7/pdf

  8. Valente M, Saggin G, Alecci V. Pure isolated dorsal dislocation of the fifth carpometacarpal joint. Musculoskeletal Surgery. 2009; 93 (2): 97-100. doi: 10.1007/s12306-009-0029-z

  9. Kadi KIE, Sbiyaa M, Alami B, Rabhi I, Marzouki A, Lahrach K, et al. Isolated radial volar dislocation of the fifth carpometacarpal joint: a rare injury. Pan African Medical Journal. 2013; 16 (90). doi: 10.11604/pamj.2013.16.90.3218.

  10. Tountas AA, Kwok JM. Isolated volar dislocation of the fifth carpometacarpal joint. Case report. Clinical orthopaedics and related research. 1984; (187): 172-175. Available in: https://europepmc.org/article/med/6744715

  11. Henderson J, Arafa M. Carpometacarpal dislocation. An easily missed diagnosis. J Bone Joint Surg Br. 1987; 69-B (2): 212-214. doi: 10.1302/0301-620X.69B2.3818751

  12. Mito K, Nakamura T, Sato K, Toyama Y, Ikegami H. Dorsal dislocations of the second to fifth carpometacarpal joints: a case report. Hand Surg. 2008; 13 (02): 129-132. doi: 10.1142/S021881040800389X.

  13. Yoshida R, Shah MA, Patterson RM, Buford WL, Knighten J, Viegas SF. Anatomy and pathomechanics of ring and small finger carpometacarpal joint injuries. J Hand Surg Am. 2003; 28 (6): 1035-1043. doi: 10.1016/s0363-5023(03)00373-3.

  14. Gangloff D, Mansat P, Gaston A, Apredoaei C, Rongières M. Les luxations carpométacarpiennes du cinquième rayon: étude descriptive à propos de 31 cas. Chir Main. 2007; 26 (4): 206-213. doi: 10.1016/j.main.2007.06.002.

  15. Sharma A, John JT. Unusual case of carpometacarpal dislocation of all the four fingers of ulnar side of hand. Med J Armed Forces India. 2005; 61 (2): 188-189. doi 10.1016/S0377-1237(05)80024-3 https://doi.org/10.1016/S0377-1237(05)80024-3

  16. Malshikare VA. An ulnar-type dislocation of fifth carpometacarpal joint: case report and review of the literature. J Hand Microsurg. 2019; 12 (S 01): S61-63. doi: 10.1055/s-0039-1680277.

  17. Gunther SF, Bruno PD. Divergent dislocation of the carpometacarpal joints: a case report. J Hand Surg Am. 1985; 10 (2): 197-201. doi: 10.1016/s0363-5023(85)80105-2.

  18. Fisher MR, Rogers LF, Hendrix RW. A systematic approach to the diagnosis of carpometacarpal dislocations. RadioGraphics. 1982; 2 (4): 612-627. doi: 10.1148/radiographics.2.4.612.

  19. Jilani LZ, Abbas M, Goel S, Akhtar MN. Multiple volar dislocations of the carpometacarpal joints with an associated fracture of the first metacarpal base. Chin J Traumatol. 2014; 17 (1): 38-40. ISSN 1008-1275. Available in: https://doi.org/10.3760/cma.j.issn.1008-1275.2014.01.008. https://www.sciencedirect.com/science/article/pii/S1008127515301127

  20. Eichhorn-Sens J, Katzer A, Meenen NM, Rueger JM. Karpometakarpale Luxationsverletzungen. Handchirur Mikrochir Plast Chir. 2001; 33 (3): 189-197. doi: 10.1055/s-2001-15130.

  21. Petrie PW, Lamb DW. Fracture-subluxation of base of fifth metacarpal. Hand. 1974; 6 (1): 82-86. doi: 10.1016/0072-968x(74)90016-3.

  22. Stevanovic MV, Stark HH. Dorsal dislocation of the fourth and fifth carpometacarpal joints and simultaneous dislocation of the metacarpophalangeal joint of the small finger: a case report. J Hand Surg Am. 1984; 9 (5): 714-716. doi: 10.1016/s0363-5023(84)80020-9.

  23. Norman R, Thurstan HC. Isolated dislocation of the base of the fifth metacarpal. British Journal of Surgery. 1936; 23 (91): 567-571. Available in: https://doi.org/10.1002/bjs.1800239110

  24. Fischer JW, Waseem M, Gambhir A, Creedon RJ. Ulnopalmar dislocation of the fifth carpometacarpal joint. A rare injury. Acta Orthop Belg. 2002; 68 (2): 175-157.

  25. Pérez-Serna A, Figueroa-Cal Y Mayor F. Fractura-luxación carpometacarpiana múltiple. Acta Ortop Mex. 2009; 23 (3): 149-152. Disponible en: https://www.medigraphic.com/cgi-bin/new/publicaciones.cgi?IDREVISTA=9&NOMBRE=Acta%20Ortop%E9dica%20Mexicana https://www.medigraphic.com/pdfs/ortope/or-2009/or093f.pdf




2020     |     www.medigraphic.com