Multiple dorsal carpometacarpal joint dislocation: case report

Abstract

Carpometacarpal joint dislocation extending from the second to fifth metacarpal is a rare injury. It usually follows high energy trauma but may be seen in low energy trauma. The diagnosis can easily be missed because of severe swelling of the hand at presentation and overlapping of the bones on radiograph of the wrist and hand. The dorsal dislocation is the commonest pattern of injury. We present a case of right dorsal carpometacarpal joint dislocation. The diagnosis was made with radiograph of the right wrist. It was managed with closed reduction and percutaneous K-wire fixation under image intensifier control. He had intensive physiotherapy and functional assessment was done using quick DASH score at regular interval on follow up. On the last follow up, 2 years later, the quick DASH score was 9.1%. The right hand was pain-free. A high index of suspicion and meticulous hand examination is important to avoid missed diagnosis of a carpometacarpal joint dislocation. Prompt reduction and fixation followed by intensive physiotherapy are necessary to achieve excellent hand function.