Multiple dislocations of the carpometacarpal joints

Multiple Dislocations of The Carpometacarpal Joints 0. 0. A. ON1 and R. P. MACKENNY From the Watford General Hospital. A case of multiple dislocations of the carpometacarpal joints associated with low energy trauma is reported. Open reduction and internal fixation has produced a good result.

Isolated dislocations or fracture-dislocations of the carpometacarpal joint are fairly common injuries. They result from forces acting directly on the carpometacarpal joints or along the axis of the shaft of the meracarpal. In contrast, simultaneous dislocations of more than one carpometacarpal joint in the same hand is -elatively rare. It is usually associated with high energy trauma and often part of multiple injuries in the same patient (Shephard, 1960; Hartwig, 1979). This injury complex has hitherto not been associated with low energy violence. Case Report

A forty-seven year old lady tripped and fell backwards onto her left hand which was trapped under her weight. Within hours a massive swelling had developed although the overall circulation of the hand was not impaired. X-rays revealed a spiral fracture of the proximal phalanx of the thumb and dorsomedial dislocations or fracture dislocations of all carpometacarpal joints of the other fingers (Figure 1). The hand was initially treated with elevation, ice packs, ananase and finger exercises. A week later, an open

Fig. 1

A spiral fracture

of proximal

Received for publication July, 1985. 0. 0. A. Oni, F.R.C.S.Ed., F.W.A.C.S. Warford WDl 8HB VOL..

II-B

No.

1 FEBRUARY

1986

phalanx

Watford

of the thumb

General Hospital,

reduction and Kirschner wire fixation of all the affected joints was performed (Figure 2). A dynamic splint was used to allow free finger movements and the wires were removed after six weeks. At three months she has regained full finger movements but wrist flexion and extension have remained restricted to only 45”. She has no pain and is pleased with the result. Discussion

Sim,ultaneous fracture-dislocations of more than one carpometacarpal joint are rare and require high energy violence because of the strong capsular attachments of the joint and the anatomical relationships of the bones. Nevertheless, the high energy forces required were generated in the circumstances of injury in this patient. The probable mechanism is that the whole of the body weight was transmitted along the axes of the metacarpal shafts. Many methods of treatment have been suggested but closed reduction is only feasible where there is no associated oedema. In addition, the fractures are inherently unstable so that closed reduction needs to be supplemented by percutaneous pinning (Hsu, 1970).

and dislocation

Vicarage

of carpometacarpal

joints

of fingers.

Road,

47

0. 0. A. ON1 AND R. P. MACKENNY

Fig.

2

Carpometacarpal

dislocations

fixed

with

Kirschner

wires.

References HARTWIG, R. H. and LOUIS, D. S. (1979). Multiple Carpometacarpal Dislocations: A Review of Four Cases. The Journal of Bone and Joint Surgery 61A: 6: 906-908. HSU, J. D. and CURTIS, R. M. (1970). Carpometacarpal Dislocations on the Ulnar Side of the Hand. The Journal of Bone and Joint Surgery 52A: 5: 927.930. D. J. (1960). Carpo-Metacarpal SHEPHARD E. and SOLOMON, Dislocation: Report of Four Cases. The Journal of Bone and Joint Surgery 42B: 4: 772-777.

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THE JOURNAL

OF HAND SURGERY