[Floating first metacarpal with recurrent trapeziometacarpal dislocation in a subject with hyperlaxity]

A case of trapezometacarpal dislocation associated with metacarpophalangeal dislocation (floating first metacarpal) is described. The trapezometacarpal dislocation re-occurred twice despite well conducted orthopedic treatment. Ligamentoplasty of the carpal radial flexor tendon using the Eaton and Littler method then provided an excellent result. Failure of orthopedic treatment was probably related to the congenital hyperlaxity presented by this patient. Considering this hypothesis, the presence of hyperlaxity would affect management practices used for trapezometacarpal dislocation. In the presence of hyperlaxity, it would be preferable to propose first-intention surgery with suture and pinning or ligamentoplasty. Conversely, for patients without hyperlaxity, orthopedic treatment remains the first-intention treatment of choice.