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Traumatic dislocation of the first carpometacarpal joint
Traumatic Dislocation of the First Carpometacarpal Joint Chadd K. Kraus DO, MPH, Kevin R. Weaver DO PII: DOI: Reference:
S0735-6757(14)00416-1 doi: 10.1016/j.ajem.2014.05.048 YAJEM 54331
To appear in:
American Journal of Emergency Medicine
Received date: Accepted date:
14 May 2014 20 May 2014
Please cite this article as: Kraus Chadd K., Weaver Kevin R., Traumatic Dislocation of the First Carpometacarpal Joint, American Journal of Emergency Medicine (2014), doi: 10.1016/j.ajem.2014.05.048
This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
ACCEPTED MANUSCRIPT Traumatic Dislocation of the First Carpometacarpal Joint
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Traumatic Dislocation of the First Carpometacarpal Joint
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Chadd K. Kraus, DO, MPH; Kevin R. Weaver, DO
MA
NU
Author Affiliations: Department of Emergency Medicine, Lehigh Valley Health Network; Allentown, PA
ED
Corresponding Author: Chadd K. Kraus, DO, MPH; [email protected]
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This manuscript has not been previously presented or published and is not currently under consideration for publication in any other journal.
AC
The authors report no conflict of interest related to this manuscript.
Word Count: 309
ACCEPTED MANUSCRIPT Traumatic Dislocation of the First Carpometacarpal Joint Highlights for Review Dislocations of the thumb CMC are rare
Specific trauma mechanisms associated with these injuries
Proper diagnosis and ED treatment can reduce morbidity and loss of function associated with the injury
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MA
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ACCEPTED MANUSCRIPT Traumatic Dislocation of the First Carpometacarpal Joint
Abstract We present a case report and review of the literature of traumatic
RI P
T
dislocation of the carpometacarpal joint of the left thumb without associated fracture. The injury was sustained while skiing and
SC
following emergency department diagnosis, the dislocation was reduced and the joint stabilized with a splint. The patient was
NU
discharged with close follow-up with a hand surgeon for definitive
MA
surgical fixation. Carpo-metacarpal joint dislocations of the thumb are exceedingly rare injuries and require appropriate diagnosis and
ED
treatment to minimize the morbidity and loss of function that can
AC
CE
PT
occur with these injuries.
ACCEPTED MANUSCRIPT Traumatic Dislocation of the First Carpometacarpal Joint
RI P
T
A 21-year-old male skier presented to the emergency department after sustaining a mechanical fall onto his left hand while holding a ski pole. There was marked deformity of the left thumb at the carpometacarpal joint, with initial exam and radiograph as shown in Figure 1. On examination, he reported pain and limited range of motion over the site of the deformity, was neurovascularly intact, and had full range of motion of his wrist and other fingers. He had no other trauma and had normal vital signs.
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DIAGNOSIS: Traumatic dislocation of the left first carpometacarpal (CMC) joint.
MA
DISCUSSION:
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Under local anesthesia, the emergency physician reduced the dislocation with traction, achieving good post-reduction anatomic alignment (Figure 2). The joint was immobilized in a short-arm thumb spica splint. In consultation with the hand surgeon, the patient was discharged home with outpatient follow-up for evaluation and operative stabilization of the joint.
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CMC dislocations are high-energy injuries, often have associated fractures, and usually involve digits two through five.1,2 CMC dislocations account for less than 1 percent of all hand injuries.3-5 First carpometacarpal (CMC) joint dislocation is a rare injury with fewer than 50 cases published in the literature.6,7 There are two forces that have been identified as causing this injury: a longitudinal force along the metacarpal when the joint is flexed, and a direct force into the web space of the thumb.8 Proper diagnosis and treatment of this injury is critical due to the potential for pain and limitation of range of motion, yet missed and delayed diagnosis is common.9,10 In cases where the diagnosis is suspected, full radiographs including PA, lateral, and oblique x-rays, and in some instances CT scan should be used in the evaluation of patients with suspected CMC dislocations.10,11 Early referral to a hand specialist is necessary for evaluation for operative or non-operative management.1,12
ACCEPTED MANUSCRIPT Traumatic Dislocation of the First Carpometacarpal Joint REFERENCES: Horneff III JG, Park MJ, Steinberg DR. Acute closed dislocation of the second through fourth carpometacarpal joints: satisfactory treatment with closed reduction and immobilization. Hand. 2013;8(2):227-31.
2.
Chick JF, Mandell JC, de Souza DA, Khurana B. Hand pain after fall. Dislocation of the fifth carpometacarpal. Ann Emerg Med. 2013;62(1):13,27.
3.
Dobyns JH, Linschield RL, Cooney III WP. Fractures and dislocations of the wrist and hand, then and now. J Hand Surg. 1983;8:687-90.
4.
Hove LM, Fractures of the hand: Distribution and relative incidence. Scand J Plast Reconstr Surg Hand Surg. 1993;27:317-19.
5.
Mueller JJ. Carpometacarpal dislocations: report of five cases and review of the literature. J Hand Surg. 1986;11A:184-88.
6.
Fotiadis E, Svarna T, Lyrtzis C, Papadopoulos A, Akritopoulos P, Chalidis B. Isolated thumb carpometacarpal joint dislocation: a case report and review of the literature. J Ortho Surg and Research. 2010;5:16.
7.
Pizon AF, Wang HE. Carpometacarpal Dislocation of the Thumb. J Emerg Med. 2010;38(3):376-77.
8.
Jeong C, Kim HM, Lee SU, Park IJ. Bilateral Carpometacarpal Joint Dislocations of the Thumb. Clin Orthop Surg. 2012;4(3):246-8.
9.
Gaheer RS, Ferdinand RD. Fracture dislocation of carpometacarpal joints: a missed injury. Orthopedics. 2011;34(5):399.
10.
Henderson JJ, Arafa MA. Carpometacarpal dislocation. An easily missed diagnosis. J Bone Joint Surg Br. 1987;69(2):212-4.
11.
El Ibrahimi A, Amar F, Chbani B, Daoudi A, Elmrini A, Boutayeb F. Dislocation of the Carpometacarpal Joint of the Thumb Associated with Trapezium and Bennett’s Fracture. Hand (NY) 2009;4(2):191-93.
12.
Bosmans B, Verhofstad MH, Gosens T. Traumatic thumb carpometacarpal joint dislocations. J Hand Surg. 2008;33(3):438-41.
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ACCEPTED MANUSCRIPT
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Traumatic Dislocation of the First Carpometacarpal Joint
FIGURE 1: Initial exam and x-ray on presentation to the ED
ACCEPTED MANUSCRIPT
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Traumatic Dislocation of the First Carpometacarpal Joint
FIGURE 2: Post-reduction exam and x-ray
S0735-6757(14)00416-1 doi: 10.1016/j.ajem.2014.05.048 YAJEM 54331
To appear in:
American Journal of Emergency Medicine
Received date: Accepted date:
14 May 2014 20 May 2014
Please cite this article as: Kraus Chadd K., Weaver Kevin R., Traumatic Dislocation of the First Carpometacarpal Joint, American Journal of Emergency Medicine (2014), doi: 10.1016/j.ajem.2014.05.048
This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
ACCEPTED MANUSCRIPT Traumatic Dislocation of the First Carpometacarpal Joint
RI P
T
Traumatic Dislocation of the First Carpometacarpal Joint
SC
Chadd K. Kraus, DO, MPH; Kevin R. Weaver, DO
MA
NU
Author Affiliations: Department of Emergency Medicine, Lehigh Valley Health Network; Allentown, PA
ED
Corresponding Author: Chadd K. Kraus, DO, MPH; [email protected]
CE
PT
This manuscript has not been previously presented or published and is not currently under consideration for publication in any other journal.
AC
The authors report no conflict of interest related to this manuscript.
Word Count: 309
ACCEPTED MANUSCRIPT Traumatic Dislocation of the First Carpometacarpal Joint Highlights for Review Dislocations of the thumb CMC are rare
Specific trauma mechanisms associated with these injuries
Proper diagnosis and ED treatment can reduce morbidity and loss of function associated with the injury
AC
CE
PT
ED
MA
NU
SC
RI P
T
ACCEPTED MANUSCRIPT Traumatic Dislocation of the First Carpometacarpal Joint
Abstract We present a case report and review of the literature of traumatic
RI P
T
dislocation of the carpometacarpal joint of the left thumb without associated fracture. The injury was sustained while skiing and
SC
following emergency department diagnosis, the dislocation was reduced and the joint stabilized with a splint. The patient was
NU
discharged with close follow-up with a hand surgeon for definitive
MA
surgical fixation. Carpo-metacarpal joint dislocations of the thumb are exceedingly rare injuries and require appropriate diagnosis and
ED
treatment to minimize the morbidity and loss of function that can
AC
CE
PT
occur with these injuries.
ACCEPTED MANUSCRIPT Traumatic Dislocation of the First Carpometacarpal Joint
RI P
T
A 21-year-old male skier presented to the emergency department after sustaining a mechanical fall onto his left hand while holding a ski pole. There was marked deformity of the left thumb at the carpometacarpal joint, with initial exam and radiograph as shown in Figure 1. On examination, he reported pain and limited range of motion over the site of the deformity, was neurovascularly intact, and had full range of motion of his wrist and other fingers. He had no other trauma and had normal vital signs.
NU
SC
DIAGNOSIS: Traumatic dislocation of the left first carpometacarpal (CMC) joint.
MA
DISCUSSION:
PT
ED
Under local anesthesia, the emergency physician reduced the dislocation with traction, achieving good post-reduction anatomic alignment (Figure 2). The joint was immobilized in a short-arm thumb spica splint. In consultation with the hand surgeon, the patient was discharged home with outpatient follow-up for evaluation and operative stabilization of the joint.
AC
CE
CMC dislocations are high-energy injuries, often have associated fractures, and usually involve digits two through five.1,2 CMC dislocations account for less than 1 percent of all hand injuries.3-5 First carpometacarpal (CMC) joint dislocation is a rare injury with fewer than 50 cases published in the literature.6,7 There are two forces that have been identified as causing this injury: a longitudinal force along the metacarpal when the joint is flexed, and a direct force into the web space of the thumb.8 Proper diagnosis and treatment of this injury is critical due to the potential for pain and limitation of range of motion, yet missed and delayed diagnosis is common.9,10 In cases where the diagnosis is suspected, full radiographs including PA, lateral, and oblique x-rays, and in some instances CT scan should be used in the evaluation of patients with suspected CMC dislocations.10,11 Early referral to a hand specialist is necessary for evaluation for operative or non-operative management.1,12
ACCEPTED MANUSCRIPT Traumatic Dislocation of the First Carpometacarpal Joint REFERENCES: Horneff III JG, Park MJ, Steinberg DR. Acute closed dislocation of the second through fourth carpometacarpal joints: satisfactory treatment with closed reduction and immobilization. Hand. 2013;8(2):227-31.
2.
Chick JF, Mandell JC, de Souza DA, Khurana B. Hand pain after fall. Dislocation of the fifth carpometacarpal. Ann Emerg Med. 2013;62(1):13,27.
3.
Dobyns JH, Linschield RL, Cooney III WP. Fractures and dislocations of the wrist and hand, then and now. J Hand Surg. 1983;8:687-90.
4.
Hove LM, Fractures of the hand: Distribution and relative incidence. Scand J Plast Reconstr Surg Hand Surg. 1993;27:317-19.
5.
Mueller JJ. Carpometacarpal dislocations: report of five cases and review of the literature. J Hand Surg. 1986;11A:184-88.
6.
Fotiadis E, Svarna T, Lyrtzis C, Papadopoulos A, Akritopoulos P, Chalidis B. Isolated thumb carpometacarpal joint dislocation: a case report and review of the literature. J Ortho Surg and Research. 2010;5:16.
7.
Pizon AF, Wang HE. Carpometacarpal Dislocation of the Thumb. J Emerg Med. 2010;38(3):376-77.
8.
Jeong C, Kim HM, Lee SU, Park IJ. Bilateral Carpometacarpal Joint Dislocations of the Thumb. Clin Orthop Surg. 2012;4(3):246-8.
9.
Gaheer RS, Ferdinand RD. Fracture dislocation of carpometacarpal joints: a missed injury. Orthopedics. 2011;34(5):399.
10.
Henderson JJ, Arafa MA. Carpometacarpal dislocation. An easily missed diagnosis. J Bone Joint Surg Br. 1987;69(2):212-4.
11.
El Ibrahimi A, Amar F, Chbani B, Daoudi A, Elmrini A, Boutayeb F. Dislocation of the Carpometacarpal Joint of the Thumb Associated with Trapezium and Bennett’s Fracture. Hand (NY) 2009;4(2):191-93.
12.
Bosmans B, Verhofstad MH, Gosens T. Traumatic thumb carpometacarpal joint dislocations. J Hand Surg. 2008;33(3):438-41.
AC
CE
PT
ED
MA
NU
SC
RI P
T
1.
ACCEPTED MANUSCRIPT
AC
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ED
MA
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RI P
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Traumatic Dislocation of the First Carpometacarpal Joint
FIGURE 1: Initial exam and x-ray on presentation to the ED
ACCEPTED MANUSCRIPT
AC
CE
PT
ED
MA
NU
SC
RI P
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Traumatic Dislocation of the First Carpometacarpal Joint
FIGURE 2: Post-reduction exam and x-ray