David Campos PachecoMexican Institute of Social Security Toluca, Mexico
Title: Isolated dorsal dislocation of the carpometacarpal joint
Introduction: pure dislocation of the carpometacarpal joint is a rare injury. There are few national publications that cover this condition. It occurs secondary to high-energy injuries. Pure dorsal dislocations occur more frequently and mainly affect the fourth and fifth metacarpals. They are often overlooked in emergency care, so they progress to the chronic stage, and are initially considered a high index of suspicion by the doctor. Objective: we present a case of late diagnosis of isolated dorsal dislocation of the fourth and fifth carpometacarpal joints that was managed surgically and review the existing literature for the diagnosis, treatment and prognosis of this rare pathology. Clinical case: a 22-year-old male with a history of direct contusion on the left wrist, which causes severe pain, increased volume, functional limitation, treated with non-steroidal anti-inflammatory drugs (NSAIDs) for four weeks without improvement. Radiographically without data of continuity solution, but with loss of joint congruence of the base of the fourth and fifth metacarpals. Diagnosing an isolated chronic dislocation of the fourth and fifth metacarpals of the left hand. Dorsal hand approach and open reduction with stabilization by placing two 1.6 mm retrograde Kirschner pins, immobilization with antebrachipalmar splint for 6 weeks and physical rehabilitation is performed. At the end of the therapeutic process, full range of motion, without visible sequelae to mobilization. Conclusions: it is important to perform a complete examination of the hand and confirm radiographically to avoid missing the diagnosis. Most dislocations present joint instability and it continues to be the determining parameter for surgical intervention. The treatment of choice continues to be open reduction and internal fixation, which allows excellent recovery of hand function.
David Campos Pacheco completed his studies as an orthopedist at the age of 30 at the Instituto Mexicano del Seguro Social, in Mexico. He is currently a young surgeon with his first publication in the Orthotips Magazine of Mexico.