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Updated: Dec 9, 2025

Metacarpal Small Incision for Carpal Tunnel Syndrome

Metacarpal Small Incision for Carpal Tunnel Syndrome

Published on: April 5, 2024

Complex, Multidirectional Carpometacarpal Dislocations: A Case Report.

Anil Dhal¹, Saket Prakash, Pulkit Kalra

¹Department of Orthopaedics, Maulana Azad Medical College & Lok Nayak Hospital, New Delhi, India.

JBJS Case Connector

|September 10, 2020

Summary

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A rare combined convergent-divergent carpometacarpal (CMC) fracture dislocation involving the median nerve was treated surgically. This case highlights the importance of advanced imaging for diagnosing complex CMC dislocations after high-energy trauma.

Area of Science:

Orthopedic Surgery
Trauma Surgery
Hand Surgery

Background:

Carpometacarpal (CMC) joint dislocations are uncommon injuries.
High-energy trauma can result in complex fracture dislocations of the CMC joints.

Observation:

A young adult sustained a rare combined convergent-divergent CMC fracture dislocation after a motorbike accident.
Radiographs demonstrated volar dislocation of the second and fifth metacarpals and dorsal dislocation of the third and fourth metacarpals.
The bases of the second and fifth metacarpals converged in the coronal plane, with associated median nerve involvement.

Findings:

Surgical intervention involving open reduction and internal fixation was performed.
Carpal tunnel release was necessary due to median nerve involvement.

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Implications:

Combined convergent-divergent CMC fracture dislocation should be considered in the differential diagnosis of CMC dislocations.
Advanced imaging, including 3D CT reconstructions and specific radiographic views (metacarpal cascade line, radial/ulnar lateral views), is crucial for accurate diagnosis.
Prompt surgical management is essential for favorable outcomes in these complex injuries.