Multiple Second to Fifth Carpometacarpal Fracture-Dislocations: A Case Report on the Surgical Management of a Rare Hand Injury

TL;DR

This case report describes a rare hand injury involving multiple carpometacarpal joint fractures and dislocations, emphasizing the need for early diagnosis and surgical treatment to avoid long-term complications.

Contribution

The paper presents a detailed case of simultaneous second to fifth carpometacarpal fracture-dislocations and highlights the importance of surgical management for optimal outcomes.

Findings

Multiple CMC fracture dislocations are rare and often missed due to complex anatomy and swelling.

Surgical stabilization using Kirschner wires, a bridge plate, and arthrodesis screw achieved adequate joint alignment.

Early diagnosis and appropriate fixation are crucial to prevent chronic pain and post-traumatic arthrosis.

Abstract

Multiple carpometacarpal (CMC) joint fracture dislocations involving the second to fifth rays are rare injuries, typically resulting from high-energy trauma. Due to the complex anatomy of the CMC joints and associated swelling, these lesions are frequently overlooked, leading to delayed diagnosis and suboptimal outcomes.

We report the case of a 21-year-old male patient who sustained simultaneous dislocations of the second through fifth carpometacarpal joints with associated fractures following a high-energy trauma to the hand due to a motorcycle accident. Initial radiographic evaluation confirmed dorsal displacement of the second to fifth metacarpal bases with fracture of the second and third metacarpal bases (Arbeitsgemeinschaft für Osteosynthesefragen (AO) 70D6(5b)), trapezoid avulsion fracture (AO 76.3.A), and hamate avulsion fracture (AO 74B). Close reduction under fluoroscopic guidance was attempted but proved unsuccessful due to the instability of the injury, requiring open reduction and internal fixation. A double dorsal surgical approach was used, and stabilization was achieved with Kirschner wires, a bridge plate, and an arthrodesis screw. Postoperative imaging demonstrated adequate joint alignment.

Multiple CMC fracture dislocations represent an uncommon injury pattern and require a high index of suspicion. Early diagnosis, appropriate imaging, and stable fixation are essential to restore joint congruency and prevent long-term complications such as chronic pain, instability, and post-traumatic early arthrosis. Given the inherent instability of these injuries, surgical management is frequently indicated.

Simultaneous fracture dislocations of the second to fifth CMC joints are rare and potentially disabling injuries. Prompt recognition and surgical stabilization can lead to satisfactory functional outcomes. This case highlights the importance of early intervention and appropriate fixation techniques in complex CMC joint injuries.

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