Dorsal dislocation of the four ulnar metacarpals

A patient presented to the emergency department (ED) with hand pain after striking a wall with a partially clenched fist. X-rays showed small dorsal carpal avulsion fractures and a dorsal dislocation of the ulnar four metacarpals. Closed reduction maneuvers reduced all but the second metacarpal. The patient underwent open reduction, internal fixation of this joint, and was healed within 6 weeks. Although typically associated with significant amounts of kinetic energy, the particular position of the hand and wrist during this injury may have allowed this dislocation pattern to occur with relatively minor trauma. A discussion of this injury, the carpometacarpal joint, and important radiographic features is presented.