Bilateral carpometacarpal joint dislocations of the thumb

Simultaneous quadruple dislocations of the hand in a motorcyclist: A case report

Herein we present a case of four simultaneous dislocations of the hand resulting from a motorcycle accident in a young man. In this case, the 1st CMC, MCP, and IP joints of the right hand were dislocated along with right perilunate dislocation. Perilunate dislocation was treated with open reduction and internal fixation. Close reduction of IP and CMC was done and CMC was fixed by pins. MCP dislocation was treated by open reduction and pinning in addition to collateral ligament and capsular repair. In follow-up excellent functional activity and range of motion were observed.

Systematic Review of Ligament Reconstruction of Traumatic Isolated Thumb Carpometacarpal Joint Dislocation

INTRODUCTION

Thumb carpometacarpal (CMC) joint dislocations are rare with minimal agreement on surgical management. The dorsoradial ligament (DRL) is the primary joint stabilizer but has not historically been reconstructed. We hypothesize that the reported reconstruction of first CMC joint dislocations primarily uses the flexor carpi radialis (FCR) without collective agreement on a surgical technique.

METHODS

A systematic review of the PubMed database from 1996 to 2022 was done. Keywords were "thumb dislocation," "thumb carpometacarpal dislocation," and "carpometacarpal joint ligament repair." Inclusion criteria included isolated, unstable thumb CMC dislocations with reconstruction. The Preferred Reporting Items for Systematic Reviews and Meta Analyses guidelines were used.

RESULTS

Four hundred thirty-seven records were identified, and nine met inclusion criteria. Two articles were cohort studies, and seven were case reports. Thirty-seven patients were included, and 26 patients had reconstruction with tendonous autograft. Twenty-five (96.2%) used the FCR and 1 (3.9%) from the palmaris longus. Three patients had reconstruction with a suture anchor. Surgical techniques varied between studies.

DISCUSSION

The recommendation of the authors recreates the DRL during autograft repair. Current repair techniques that recreate the DRL use the FCR, but quantitative comparisons of tendonous autografts or suture anchors have not been done.

Management of Acute and Chronic Thumb CMC Joint Dislocations

Isolated dislocations of thumb CMC joints are rare injuries with serious functional implications. Patients suffering these injuries will have decreased pinch and grip strength. A high-energy, axially directed force on a flexed thumb typically causes dislocation. Chronically dislocated thumb CMC joints may be due to untreated remote trauma, hypermobility, or connective tissue disorders. Roberts and CMC stress view radiographs help identify joint dislocations. Treatment of these injuries includes closed reduction and immobilization, percutaneous pinning, open reduction with direct repair, and ligament reconstruction. Timely identification, timely treatment, and proper hand therapy often lead to adequate joint stability with minimal residual pain.

Recurrent Bilateral Basilar Joint Subluxation in a Teenage Boy

Carpometacarpal (CMC) joint instability may be caused by either joint trauma or systemic ligamentous laxity in a setting of connective tissue disorders. Bilateral CMC joint dislocation is extremely rare and has only been described in 2 cases, both resulting from high-energy mechanisms in adults. Here, we present a case of recurrent, bilateral CMC joint subluxation and dislocation resulting from low-energy mechanisms in a pediatric patient with no diagnosable connective tissue disorder. Over a course of 4 years, the patient underwent 10 procedures, including bilateral closed reduction and immobilization, bilateral closed reduction and percutaneous pinning, bilateral tightrope placement, and eventual bilateral tightrope revision with anterior oblique ligament reconstruction. To date, the optimal treatment options for bilateral, low-energy CMC dislocations have not been well described, and these depend on the time from injury to closed reduction as well as postreduction joint stability. Tightrope placement and ligamentous reconstruction may be required in a setting of long-term instability.

Traumatic Isolated Thumb Carpometacarpal Joint Dislocation - Report of Two Clinical Cases

Isolated thumb carpometacarpal joint dislocation is a rare lesion that accounts for less than 1% of all hand lesions.

The authors present two cases of traumatic isolated thumb carpometacarpal joint dislocation. One of them was treated with closed reduction and cast immobilization, and the other was treated with closed reduction, Kirschner-wires pinning, and cast immobilization.

The first patient had a good functional outcome and showed no signs of thumb carpometacarpal instability. The patient treated with Kirschner wires presented signs of clinical instability and radiological subluxation.

Isolated thumb carpometacarpal dislocation is a rare lesion that can cause joint instability, which interferes with the normal function of the hand and can lead to articular degenerative changes.

The best management of this lesion is still controversial, since there is lack of evidence in the literature showing superiority of one treatment over the other.

Management of thumb carpometacarpal joint dislocations: A systematic review

Although rare, thumb Carpometacarpal (CMC) joint dislocations can have significant complications which impact hand function. Optimal management is crucial in restoring pinch and grasp strength, but no agreement exists regarding treatment due to a paucity of literature on this subject. Systematic review was conducted involving non-operative and operative management of the CMC joint. 15 articles with a total of 60 thumbs were evaluated from published literature. 12/60 thumbs with isolated CMC joint dislocations were treated with closed reduction, with 4 cases needing additional ligament repair due to joint instability post-reduction. 51/60 of the isolated CMC joint dislocations had ligament reconstruction, with flexor carpi radialis tendon autograft (29/51) as the most popular option. 60/60 patients regained full function and stability of the CMC joint with significant pain relief. Although good surgical outcomes have been achieved, long term clinical outcome reporting is needed to develop a standardized approach to treatment.

Isolated first carpometacarpal joint dislocation managed with closed reduction and splinting

A 56-year-old man, right-hand-dominant office worker, complained of pain and swelling at the base of his right thumb after using his hand to press onto the front passenger seat during an emergency brake. X-ray showed a dorsal dislocation of the first carpometacarpal joint of his right hand. Closed reduction of the joint was performed. As there were no clinical signs of instability post-reduction and X-ray confirmed that the joint was congruent, the joint was immobilised in a thumb spica splint for 6 weeks. His pain subsided and the range of motion of his first carpometacarpal joint was full at 9 weeks post-injury. Two years after the injury, he was asymptomatic and X-ray revealed normal joint anatomy with no obvious subluxation or osteoarthritic change. For patients with first carpometacarpal joint dislocations, non-operative management with splinting is a good option if the joint is stable post-reduction.

Chronic Carpometacarpal Dislocation of the Thumb: A Case Report and Review of the Literature

CASE

We report a case of a chronic, irreducible carpometacarpal (CMC) dislocation of the thumb, which was managed with a trapeziometacarpal arthrodesis.

CONCLUSION

This case demonstrates that arthrodesis is a suitable salvage procedure for chronic, irreducible CMC dislocations of the thumb.

Thumb Injuries in Athletes

Thumb injuries are common in athletes and present a challenging opportunity for upper extremity physicians. Common injuries include metacarpal base fractures (Bennett and Rolando types), ulnar and radial collateral ligament injuries, dislocation of the carpometacarpal and metacarpophalangeal joints, and phalanx fractures. This review, although not exhaustive, highlights some of the most common thumb injuries in athletes. The treating physician must balance pressure from athletes, parents, coaches, and executives to expedite return to play with the long-term well-being of the athlete. Operative treatment may expedite return to play; however, one must carefully weigh the added risks involved with surgical intervention.

Rare carpometacarpal dislocations

Posttraumatic carpal and carpometacarpal dislocations represent a heterogeneous group of disorders resulting from high-energy wrist trauma. Perilunate injury is the most common and best-known manifestation of carpal dislocation, typically occurring after hyperextension trauma. Other forms are very rare and have different causative mechanisms. Carpometacarpal (CMC) dislocations are also uncommon and may affect isolated or multiple CMC joints. These lesions are prone to wrist instability if not treated promptly. The aim of this article is to provide a systematic radiologic approach to the evaluation of wrist injury and to present two acute cases of rare CMC dislocations.

An alternative technique for stabilisation of the carpometacarpal joint of the thumb after dislocation or subluxation

We report a new surgical technique for the treatment of traumatic dislocation of the carpometacarpal (CMC) joint of the thumb. This is a tenodesis which uses part of the flexor carpi radialis.

Between January 2010 and August 2013, 13 patients with traumatic instability of the CMC joint of the thumb were treated using this technique. The mean time interval between injury and ligament reconstruction was 13 days (0 to 42). The mean age of the patients at surgery was 38 years: all were male.

At a mean final follow-up of 26 months (24 to 29), no patient experienced any residual instability. The mean total palmar abduction of the CMC joint of the thumb was 61° and the mean radial abduction 65° The mean measurements for the uninjured hand were 66° (60° to 73°) and 68° (60° to 75°), respectively. The mean Kapandji thumb opposition score was 8.5° (8° to 9°). The mean pinch and grip strengths of the hand were 6.7 kg (3.4 to 8.2) and 40 kg (25 to 49), respectively. The mean Disabilities of the Arm, Shoulder, and Hand questionnaire score was 3 (1 to 6). Based on the Smith and Cooney score, we obtained a mean score of 85 (75 to 95), which included four excellent, seven good, and two fair results.

Our technique offers an alternative method of treating traumatic dislocation of the CMC joint of the thumb: it produces a stable joint and acceptable hand function.

Cite this article: Bone Joint J 2015;97-B:1533–8.

First Carpometacarpal Joint Dislocation and Review of Literatures

Dislocation of the first carpometacarpal (CMC) is a rare occurrence. Treatment of this dislocation varies from closed reduction and casting to ligament repair. Neglected dislocation or incomplete reduction of the 1(st) CMC cause chronic instability and painful arthritis, muscle imbalance and decreased grip force. In our study 6 patients is evaluated that were visited in less than 24 hours from their injury. All were primarily reduced and except one patient later injured ligament were repaired. All patient after 6 months had normal range of motion without pain and they had not any complaint. Stability at the 1(st) CMC joint is dependent on static and dynamic forces. However, dislocation of the 1(st) CMC occur rare, but important function of the thumb specially in gripping and grasping makes it a significant problem. Injured ligament should repair for increased stability of 1(st) CMC joint, because neglected dislocation or incomplete reduction cause chronic instability and painful arthritis.