Simultaneous dorsal dislocations of the carpometacarpal joints of all four fingers.
A 57-year-old right-hand-dominant woman was involved in a motor vehicle collision. Upon examination, her right hand was markedly deformed and swollen, with limited range of movement. Plain radiographs revealed dorsal dislocations of the index, long, ring, and small finger carpometacarpal joints and an avulsion fracture of the dorsal aspect of the capitate. Closed reduction was unsuccessful. Closed reduction under general anesthesia was successful on the carpometacarpal joint of the ring and small fingers, however, the long and index fingers remained irreducible. An open approach revealed that a joint capsule was interposed in the carpometacarpal joints of the long and index fingers, preventing reduction. Kirschner wires were placed through the base of the small and ring finger metacarpals into the carpus. Additional K-wires were placed across the base of the index and long finger metacarpals into the carpus, and removed at 6 weeks. The avulsion fracture of the capitate was not addressed. Follow-up at 24 months demonstrated full range of motion in all fingers. Her DASH Outcome Measure score was 1.7. She was pain free, had full grip strength, and returned to work full-time. Whether patients are treated closed or open, appropriate treatment of carpometacarpal dislocations usually leads to excellent outcomes. If closed reduction is unsuccessful, open treatment is required to address any soft tissue that is preventing reduction. Although urgent treatment is preferred, delay in reduction of up to 4 weeks has been shown not to compromise results.
Peace
William J
WJ
Department of Orthopedic Surgery, University of California San Diego Medical Center, San Diego, CA 92103-8894, USA. wjpeace@hotmail.com
Abrams
Reid A
RA
D001864:Bone Wires; D052737:Carpometacarpal Joints / Q000293:injuries* / Q000601:surgery*; D005260:Female; D005383:Finger Injuries / Q000601:surgery*; D005593:Fracture Fixation, Internal / Q000295:instrumentation* / Q000379:methods; D006801:Humans; D004204:Joint Dislocations / Q000601:surgery*; D008875:Middle Aged; D009104:Multiple Trauma / Q000601:surgery*; D016896:Treatment Outcome