Recurrent Pediatric Thumb Carpometacarpal Joint Dislocation Due to Generalized Joint Laxity Successfully Treated With Ligament Reconstruction: A Case Report

TL;DR

A child with recurring thumb joint dislocation due to joint laxity was successfully treated with ligament reconstruction, offering a new approach for similar pediatric cases.

Contribution

This is the first reported case of successful ligament reconstruction for thumb CMC joint dislocation in a child with generalized joint laxity.

Findings

Recurrent thumb CMC joint dislocation in a child was successfully treated with Eaton-Littler’s ligament reconstruction.

Ligament reconstruction using the flexor carpi radialis tendon improved joint stability in a pediatric patient with hyperjoint laxity.

Primary ligament reconstruction is recommended for children with systemic joint laxity or recurrent dislocations.

Abstract

Acute traumatic dislocation without fractures of the thumb carpometacarpal (CMC) joint is extremely rare in children. Treatment options, such as closed reduction with casting or pinning and open reduction with primary ligament repair, remain controversial. Here, we report the first case of an 11-year-old boy with recurrent left thumb CMC joint dislocation due to idiopathic generalized hyperjoint laxity, even after primary open reduction with capsular ligament repair of the thumb CMC joint, eventually treated with Eaton-Littler’s ligament reconstruction. Intraoperatively, a drill hole was made in the base of the first metacarpal bone while carefully preventing growth plate injury. Primary ligament reconstruction of the thumb CMC joint may be considered in pediatric cases with systemic hyperjoint laxity or recurrent thumb CMC joint dislocation. In such cases, Eaton-Littler’s ligament reconstruction is recommended for thumb CMC joint stability because two prime stabilizers of the dorsoradial ligament and the volar anterior oblique ligament (AOL) are appropriately reconstructed by a half-slip of the flexor carpi radialis tendon.

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