Dislocated 4th and 5th carpometacarpal joints
Fall of motorbike at speed.
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Dorsally dislocated 4th and 5th carpometacarpal joints. No fracture evident. Shortening of the 4th metacarpal and malalignment of the 4th and 5th CMC joints on the frontal views.
These dislocations may be associated with small intra-articular fractures of the metacarpal heads or adjacent carpals which may be occult on X-ray, and therefore CT is often perform after relocation.
On the AP view only, the dislocations may be missed and in the viva exam setting the examiner may withhold the lateral until the candidate comments on the shortening of the 4th metacarpal and malalignment of the 4th and 5th CMC joints on the AP view.