Carpometacarpal joint dislocation
Citation, DOI & article data
Carpometacarpal (CMC) joint dislocations are uncommon dislocations of the hand.
There is a strong younger male predominance. These injuries account for less than 1% of hand injuries 4 and are more common in the dominant hand.
The following injuries should raise the suspicion of carpometacarpal joint dislocations:
- base of metacarpal fracture (common). In these cases, while the fracture does not require anatomical reduction, the carpometacarpal joint requires reduction and fixation as described above.
- hook of hamate fracture
- punching (most common)
The patient may present with ulnar deviation of the 5th digit if just the 5th carpometacarpal joint is dislocated. A mass may be present in cases of 3rd, 4th, and 5th joint dislocation. Often the hand is so grossly swollen that these features may not be readily apparent.
Loss of the clear joint space and zigzag or M-shape pattern between the carpals and metacarpals on the PA projection, although this may be sometimes seen in normal patients. The dislocation may only clearly be shown on oblique or lateral projections.
Treatment and prognosis
These injuries are usually unstable after reduction and therefore are managed operatively by either closed or open reduction with K-wire fixation. The K-wires are removed after 6 weeks at which time range of movement exercise begins 4.
- 1. Henderson JJ, Arafa MA. Carpometacarpal dislocation. An easily missed diagnosis. J Bone Joint Surg Br. 1987;69 (2): 212-4. Pubmed citation
- 2. Apergis E. Fracture-Dislocations of the Wrist. Springer Science & Business Media. (2013) ISBN:8847053285. Read it at Google Books - Find it at Amazon
- 3. Lahiji F, Zandi R, Maleki A. First Carpometacarpal Joint Dislocation and Review of Literatures. (2015) The archives of bone and joint surgery. 3 (4): 300-3. Pubmed
- 4. Pundkare GT, Patil AM. Carpometacarpal Joint Fracture Dislocation of Second to Fifth Finger. (2015) Clinics in orthopedic surgery. 7 (4): 430-5. doi:10.4055/cios.2015.7.4.430 - Pubmed