Case Report


Volar dislocation of the second and third carpometacarpal joints: A case report and detailed mechanism of injury

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1 MS, Medical Student, Florida State University College of Medicine, Tallahassee, FL, USA

2 MS, Medical Student, University of Puerto Rico School of Medicine, San Juan, PR, USA

3 MD, Orthopaedic Hand Surgeon, Florida Orthopaedic Institute, Tampa, FL, USA

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Nicholas D Thomas

MS, 1115 West Call Street, Tallahassee, FL,

USA

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Article ID: 100028Z14NT2022

doi: 10.5348/100028Z14NT2022CR

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How to cite this article

Thomas ND, Rodríguez SF, Lopez P. Volar dislocation of the second and third carpometacarpal joints: A case report and detailed mechanism of injury. J Case Rep Images Orthop Rheum 2022;6:100028Z14NT2022.

ABSTRACT


Introduction: Carpometacarpal (CMC) joint dislocations are rare injuries that are difficult to diagnose radiographically. The third metacarpal articulates with the capitate bone at the wrist more proximally, and forms the strongest of all CMC joints. Therefore, dislocation of this joint may lead to an increased risk of instability and failed reduction. The present case highlights a unique injury pattern that is frequently overlooked.

Case Report: A 28-year-old man presented for examination of his left hand after a high velocity fall while skateboarding. A video recording provided at the office visit depicted the inciting injury. The converging forces during the fall caused hyperextension of the wrist at the base of the second and third metacarpal bones. Initially after this incident he arrived at the emergency department where computed tomography (CT) scans were interpreted as normal. Two weeks later, he presented in clinic with increased weakness and pain and X-rays showed dislocation of the second and third CMC joint. The following day, open reduction and external fixation (ORIF) was performed. Eight weeks after surgery, the patient presented with excellent range of motion, and X-rays of the hand showed stable articulation of the second and third CMC joints.

Conclusion: Few cases of volar dislocations of the second and third CMC joints have been reported. Treatment for CMC joint dislocation is controversial. However, early ORIF has shown excellent clinical outcomes for patients with multiple CMC dislocations. Thorough clinical and radiographic examination is necessary to prevent chronic dislocation which may lead to diminished grip strength, nerve damage, and carpal instability.

Keywords: Carpometacarpal, CMC, Dislocation, Volar, Wrist

SUPPORTING INFORMATION


Author Contributions

Nicholas D Thomas - Acquisition of data, Analysis of data, Interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published

Sebastián Frontera Rodríguez - Acquisition of data, Analysis of data, Revising it critically for important intellectual content, Final approval of the version to be published

Peter Lopez - Substantial contributions to conception and design, Interpretation of data, Revising it critically for important intellectual content, Final approval of the version to be published

Guarantor of Submission

The corresponding author is the guarantor of submission.

Source of Support

None

Consent Statement

Written informed consent was obtained from the patient for publication of this article.

Data Availability

All relevant data are within the paper and its Supporting Information files.

Conflict of Interest

Authors declare no conflict of interest.

Copyright

© 2022 Nicholas D Thomas et al. This article is distributed under the terms of Creative Commons Attribution License which permits unrestricted use, distribution and reproduction in any medium provided the original author(s) and original publisher are properly credited. Please see the copyright policy on the journal website for more information.