Surgical Treatment of a Dorsal Fifth Carpometacarpal Dislocation Associated with a Fourth Metacarpal Base Fracture: A Case Report

Vollständiger Abstract

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Background: Carpometacarpal dislocations are uncommon, frequently overlooked injuries that may cause substantial functional impairment when diagnosis and stabilisation are delayed. Case presentation: A 19-year-old man sustained a closed injury to the right hand after a heavy metal object fell on it. Radiographs demonstrated a dorsal dislocation of the fifth carpometacarpal joint associated with a fracture of the fourth metacarpal base. The initial closed reduction was unstable. Reduction under regional anaesthesia and percutaneous Kirschner-wire fixation to the distal carpal row were therefore performed, while the fourth metacarpal fracture was treated conservatively. The wires were removed after 45 days, and active rehabilitation began during the fourth postoperative week. Outcome: At three months, carpometacarpal alignment was maintained and the patient had returned to work. At six months, muscle strength was good and wrist and finger motion had almost completely recovered. Conclusion: Systematic radiographic assessment and stable fixation of unstable injuries can provide a favourable functional outcome.