Clinical outcomes in management of dislocation of carpometacarpal joints of hand: a rare orthopaedic presentation
Keywords:Carpometacarpal, Dorsal, Volar, Quick DASH
Background: Dislocation of carpo-metacarpal (CMC) joints especially involving the 2nd and 3rd or paired dislocations, presents a rare pattern of orthopaedics hand injuries. They are associated with high energy trauma usually involving motorbike accidents. Severe soft tissue inflammation over the affected hand and associated injuries often makes detection of these fractures difficult. They require prompt management at presentation. Failure to be diagnosed and treated at early stage leads to joint stiffness, restrictions of wrist movement, deformity and sometimes ruptures of tendons crossing the wrist. Most of them require open reduction and internal fixation for stabilization. The objective of the study was to clinically evaluate outcomes in management of carpometacarpal joint dislocations.
Methods: We prospectively studied 6 cases of CMC dislocation presenting at average of 1week from the original injury. All were clinically and radiologically evaluated. 3 cases were managed with open reduction and internal fixation with K wire and 1with closed manipulation and percutaneous k wire fixation and 1 case by arthrodesis of CMC joint. Functional assessment was done with Quick DASH score at 6 weeks, 3 months, 6 months and 1 year.
Results: All the patients went on to have good functional recovery. The average quick DASH score showed improvement from 77.39 to 4.07 over 1 year follow-up.
Conclusions: Careful and meticulous examinations of hands are necessary in high velocity trauma cases to avoid missing diagnosis of CMC dislocation. ORIF remains the gold standard treatment which can also be used for cases presenting late, followed by aggressive post-op physiotherapy can lead to excellent recovery of hand function.
Sharma AK, John JT. Unusual case of carpometacarpal dis-location of all the four fingers of ulnar side of hand. Med J Armed Forces India. 2005;61(2):188-9.
Kneife F. Simultaneous dislocations of the five carpometacarpal joints. Injury. 2002;33(9):846
Henderson JJ, Arafa MA. Carpometacarpal dislocation: an easily missed diagnosis. J Bone Joint Surg Br. 1987;69(2):212-4
Yadav V, Marya KM. Divergent multiple carpometacarpal fracture dislocation. J Orthopaed Traumatol. 2002;3:113–5.
Gunther SF, Bruno PD. Divergent dislocation of the car-pometacarpal joints: a case report. J Hand Surg Am. 1985;10(2):197-201.
Henry M. Fractures and dislocations of the hand. In: Bucholz RW, Heckman JD, Editors. Rockwood and Green’s Fractures in Adults. 5th ed. Lippincot: Williams & Wilkins; 2002: 721-723.
Sharma AK, John JT. Unusual Case of Carpometacarpal Dislocation of All the Four Fingers of Ulnar Side of Hand: MJAFI. 2005;61:188-9.
Tubiana R. Functional anatomy. In: Tubiana R, Thomine JM, Mackin E, eds. Examination of the Hand and Wrist. Philadelphia, PA: WB Saunders Company; 1998: 112-114.
El-Shennawy M, Nakamura K, Patterson RM, Viegas SF. Three-dimensional kinematic analysis of the second through fifth carpometacarpal joints. J Hand Surg Am. 2001;26(6):1030-5
Mueller JJ. Carpometacarpal dislocations: report of five cases and review of the literature. J Hand SurgAm. 1986;11(2):184-8.
Shih KS, Tsai WF, Wu CJ, Mudgal C (2006) Simultaneous dislocation of the Carpometacarpal and Metacaprophalageal joints of the thumb in a motorcyclist. J Formos Med Assoc. 2006;105(8):670-3.
Jupiter BJ, Belsky MR. Fractures and dislocations of the hand. In: Browner BD, Jupiter JB, Levine AM,Trafton PG, eds. Skeletal Trauma. Philadelphia, PA: WB Saunders Company; 1992: 925-929.