Total carpometacarpal joint dislocation combined with trapezium fracture, trapezoid dislocation and hamate fracture

Multiple metacarpal dislocations combined with carpal fracture - dislocations are rare injuries. We report a new combination of these injuries where fracture-dislocation of the base of the 1st metacarpal bone occurred simultaneously with a comminuted fracture of the trapezium, dislocation of the trapezoid and metacarpal joints (2nd to 5th) and an avulsion fracture of the hamate. This specific carpal injury has not been previously described and our description will contribute to understanding the mechanism of these complex injuries. The injury pattern in the case featured here was multifaceted and resulted from rupture of both transverse and longitudinal carpal columns. According to the Garcia-Elias classification of axial carpal disruptions, this particular injury mechanism was a combined axial-radial-ulnar type injury. These injuries are extremely rare and are only sporadically described in the literature. Trapeziectomy, followed by open, partial, low-profile screw fixation of the fracture of the first metacarpal and open reduction and pinning of the carpometacarpal joints and the trapezoid injury yielded a good result at the 1-year follow-up.