Chronic dislocations of the fourth and fifth carpometacarpal joints with successful treatment by ligament repair: A case report and literature review
Hiroyuki Kono1,2
, Masanori Saito2, Nobutaka Sato2, Satoshi Ochiai2, Jiro Ichikawa1, Masanori Wako1, Hirotaka Haro1, Tetsuo Hagino2
1Department of Orthopaedic Surgery, Faculty of Medicine, University of Yamanashi, Chuo, Japan
2Department of Orthopaedic Surgery, National Hospital Organization Kofu National Hospital, Yamanashi, Japan
Keywords: Carpometacarpal joint dislocation, chronic, diagnosis, ligament repair, open reduction, treatment, ulnar carpometacarpal.
Abstract
Dislocations of the fourth and fifth carpometacarpal joints (CMCJs) are rare and often misdiagnosed via radiography. Moreover, treatment strategies have not yet been standardized. Herein, we report a case of chronic dislocations of the fourth and fifth CMCJs with delayed diagnosis and successful treatment via ligament repair. A 29-year-old male patient who was initially diagnosed with contusion at another center following a fall on the stairs was referred to our hospital one month later due to persistent pain and swelling. Fourth and fifth CMCJ dislocations were diagnosed using radiography and computed tomography. Closed reduction attempts were unsuccessful, prompting open reduction. The operative findings included rupture of the dorsal carpometacarpal ligament and hamate cartilage injury. Using two mini anchors, the fourth and fifth dorsal carpometacarpal ligaments were repaired, and Kirschner-wire (K-wire) pinning was performed. The K-wire was extracted after four weeks. At the eight-month follow-up, the only remaining symptom was mild discomfort, and the range of motion and grip strength was fully recovered. Our findings highlight the difficulties in diagnosing CMCJ dislocation and suggest ligament repair as a treatment option for chronic cases of CMCJ dislocation.
Citation: Kono H, Saito M, Sato N, Ochiai S, Ichikawa J, Wako M, et al. Chronic dislocations of the fourth and fifth carpometacarpal joints with successful treatment by ligament repair: A case report and literature review. Jt Dis Relat Surg 2024;35(3):699-705. doi: 10.52312/jdrs.2024.1724.
A written informed consent was obtained from patient.
Conception and design: H.K., M.S., N.S., J.I., T.H.; Provision of study materials or patients: H.K., M.S., N.S., S.O., T.H.; Data collection and analysis: H.K., M.S., N.S., T.H.; Manuscript writing: H.K., J.I. All the authors read and approved the final manuscript.
The authors declared no conflicts of interest with respect to the authorship and/or publication of this article.
The authors received no financial support for the research and/or authorship of this article.
The authors thank Ms. Kahori Sano, Azusa Sakamoto, and Sachiko Ichimura for their secretarial assistance.
The data that support the findings of this study are available from the corresponding author upon reasonable request.