An Isolated Pure Dislocation of Fifth Carpometacarpal Joint: Case Report and Review of Literature

Isolated Volar Dislocation of the Fifth Carpometacarpal Joint

Background: Isolated dislocation of the carpometacarpal (CMC) joints is a rare injury that accounts for less than 1% of hand injuries. Few cases of isolated volar dislocations of the fifth CMC joint have been reported, making such injuries worthy of reporting. Given the rarity of these injuries, they are easily overlooked in the emergency setting and thus require a high index of clinical suspicion.

Case Report: A 57-year-old female sustained an isolated volar dislocation of the fifth CMC joint when she fell onto her outstretched right hand. Physical examination revealed an inability to move the fifth digit, and the patient reported severe pain over the ulnar aspect of her right hand. X-rays of the right wrist revealed the dislocation. The patient was managed with closed reduction and application of an ulnar gutter splint.

Conclusion: Solitary dislocations of any CMC joint are less common than simultaneous dislocation of multiple CMC joints, especially at the fifth CMC joint with volar dislocation. Because of the potential long-term adverse effects of untreated dislocations, these injuries must not be overlooked. Thus, patients presenting to the emergency department after traumatic injury involving an axial loading force to the hand should be carefully evaluated.

Nonoperative Treatment of Ulnar Carpometacarpal Fracture-Dislocations

Background  Ulnar carpometacarpal (CMC) joint dislocations and fracture-dislocations are uncommon injuries that are often overlooked. Most authors advocate surgical stabilization in order to prevent a secondary dislocation assuming that these injuries are inherently unstable. Case Description  This is a series of eight ulnar CMC joint dislocations and fracture-dislocations treated by closed reduction and splint immobilization after assessing the joint stability. Mean follow-up was 30.2 months, and minimum follow-up was 12 months. Satisfactory results were obtained in range of motion, grip strength, pain, DASH (Disabilities of the Arm, Shoulder and Hand) questionnaire, and time to return to working activities. In the same period, the closed reduction and cast failed two (20%) cases that were referred for surgery. Literature Review  There is little published literature on the nonoperative treatment of these injuries. Most of them are isolated case reports, whereas the largest series reports four cases. All of them have reported satisfactory results. Clinical Relevance  Based on our results, we believe that if the diagnosis of an ulnar CMC joint dislocation or fracture-dislocation is early accomplished and a concentric and stable reduction is initially achieved, the nonoperative treatment may be a successful option to take into account but requiring a close follow-up for the first week.

New Locked-Wire-Type External Fixator (the Ichi-Fixator) for Fourth and Fifth Carpometacarpal Joint Dislocation

We developed a new fixation method that involves the insertion of two wires and external wire fixation using a metal clamp. The aim of this technique was to increase the stability and rigidity of conventional percutaneous Kirchner wire fixation. Here, we present a patient with dislocation of the fourth and fifth carpometacarpal joints who was satisfactorily treated with closed reduction and percutaneous fixation with a linking external wire fixator (Ichi-Fixator). Operative treatment using the Ichi-Fixator system facilitates anatomical reduction and immediate full mobilization, resulting in good outcomes. The patient could perform all routine activities with normal grip strength and a full range of hand motion without pain. Such a treatment that improves comfort after the operation and may allow an immediate return to work will clearly boost patient satisfaction. Linked external wire-type fixation enables enhanced security of fixation, facilitates postoperative mobilization, and may allow an immediate return to work.

Isolated ulnopalmar dislocation of the fifth carpometacarpal joint

Dislocations of the carpometacarpal (CMC) joints are uncommon and are frequently missed on standard radiographs of the hand. Dislocations could be dorsal or palmar; dorsal dislocations are seen more frequently. Palmar dislocations can be either ulnopalmar or radiopalmar. Stable CMC dislocations could be successfully treated conservatively, while unstable dislocations are mostly treated operatively. The purpose of this report is to present a patient with an isolated ulnopalmar dislocation of the fifth CMC joint, satisfactorily treated with closed reduction and casting.