Management of Rare Case of Missed Fracture-Dislocation of Second and Third CMC Joints: A Missed Injury Case Report

Abstract

Isolated fracture-dislocation of the second and third carpometacarpal joints (CMC) is very rare, and it is commonly misdiagnosed. Injury to this joint is usually associated with high-energy trauma, like a motor vehicle accident. Despite correct diagnosis, optimal treatment for these injuries is still controversial. We present a 31-year-old male patient with a history of one-month-old injury to his right hand following a motorcycle accident. Initially, he was treated by one of the orthopedic surgeons elsewhere and misdiagnosed as having blunt trauma to the hand. On presentation, he complained of persistent pain and swelling with deformity of the right hand following the initial treatment he received. Apparently, only AP and Oblique radiographs of the hand were taken. Treatment On clinico-radiological evaluation, he was found to have a fracture dislocation of 2nd and 3rd CMC joints. He was managed with open reduction and percutaneous pinning with K-wires. Since the majority of these injuries have a higher chance of misdiagnosis, we recommend careful clinical examination, a high index of suspicion in cases of high-energy injury, and taking all three standard view radiographs of the hand.