First Through Third Carpometacarpal Dislocation Variant With
Dislocation of the 2 nd and 3 rd carpometacarpal (CMC) joints6 and variations thereof, including scapho-trapezium-trapezoid (STT) dislocations7 are rare injuries, constituting less than 1% of osseous hand injuries. Typically, a violent mechanism is required, due to the strong ligamentous attachments in the area and congruity/intrinsic stability of the joints.3,5,6 Dislocation of the 1 st CMC joint with concomitant fracture of the trapezium is a rare injury but has been reported by multiple authors.1
After a thorough review of the literature and the reported patterns we report a novel fracture dislocation variant of the first through third CMC joints: a thumb CMC dislocation with concomitant minimally displaced trapezium fracture, trapezoid dislocation and 3 rd CMC dislocation.

Case Report
A 60 year old, right hand dominant man was hit in the head by a tree while working in his yard and landed onto his hand, unsure of the position of the hand during impact. Upon arrival to the ED from an outside hospital, he was found to have a swollen and tender left hand with obvious deformity in the CMC area. His hand was warm, well perfused and motor function/sensation was intact in the median, ulnar, and radial nerve distributions. Associated injuries were head lacerations, bloody nares, skull fractures and pneumocephalus. Plain radiographs revealed the above described injury (Figure 1). Additional imaging (fluoroscopy in the ED and a CT) further delineated the injury ....