Uncommon Encounter: Carpometacarpal Dislocation of 2nd-5th Digits without Concomitant Fractures - A Rare Case Report

Carpometacarpal (CMC) joint dislocations represent <1% of all injuries to the hand and wrist regions. Up to 70% of CMC dislocations are missed or misdiagnosed due to severe swelling and overlapping of bones on the radiograph of the wrist.

We report the case of a 36-year-old male patient, following a road traffic accident, who complained of pain and swelling in his left hand. On plain radiographs, 2nd-5th CMC joints dislocation without any fracture was found, confirmed on computed tomography scan . Closed reduction with manual traction and slab application was attempted, but it was unsuccessful as it was precarious. The patient was then taken up for surgery. Third CMC joint reduction to its articulation with the capitate with a retrograde K-wire remains the cornerstone for achieving the reduction of the remaining CMC joints. Once that was achieved, the 2nd, 4th, and 5th CMC joint reduction was done and fixed with K-wires. An additional intermetacarpal wire from 5th to 4th was used for extra stability for the highly mobile 4th and 5th CMC joints. Dynamic fluoroscopy showed stable fixation and reduction. K-wires were removed after 6 weeks, and physiot-herapy was started.

At the 1-year follow-up, the patient showed stable joints with good hand grip and full range of motion (ROM). Hence, careful hand examination and radiographic assessment are necessary to avoid missing the diagnosis. Anatomic reduction and fixation with K-wires done at the earliest is the treatment of choice.