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Carpometacarpal fracture dislocation

Case contributed by Frank Gaillard
Diagnosis almost certain

Presentation

Assaulted one day ago. Swollen right hand and wrist. Decreased range of motion.

Patient Data

Age: 30 years
Gender: Male

AP, oblique and lateral views of the right hand and wrist have been performed.  

There is a comminuted, fracture of the base of the 4th metacarpal involving the articular surface. On lateral projection the carpometacarpal joint of the 4th digit appears disrupted with dorsal subluxation/dislocation of the base of the 4th metacarpal, resulting in palmar angulation and shortening. Bone fragments projected posteriorly to the fracture on the lateral projection probably have their origin from the 4th metacarpal.  

A small bone fragment is also seen at the base of the 5th metacarpal on oblique projection, presumably representing another fracture.

No other fracture is identified.  

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