Isolated Palmar Dislocation of the Trapezoid Associated With
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A 49-year-old man reported after a motor vehicle accident with multiple traumatic injury over 4 limbs and blunt injury to the abdomen. While focusing on his left hand, he had difficulty moving his right wrist and index finger due to pain. The radiographs showed a left distal radius fracture with distal radioulnar joint dislocation and subtle migration of the left trapezoid. Due to the patient’s unstable hemodynamic status, exploratory laparotomy was arranged to stop bleeding.

Following surgery, open reduction and internal fixation (ORIF) for his multiple fracture was performed and external skeleton fixation was applied to the left wrist. Due to a lesion over the trapezoid, the external fixator was secured to the patient’s third metacarpal. The palmar dislocation of the trapezoid and the dorsal dislocation of the second metacarpal was postoperatively confirmed by radiograph and computed tomography (CT) findings. On the 7th day of hospitalization, doctors performed ORIF for the left distal radial fracture with a plate and fixed the distal radial ulnar joint with a Kirschner wire by removing the primary external skeletal fixation. As for the trapezoid and the second metacarpal dislocation, a horizontal incision on the dorsal aspect of the wrist was made.

With the wrist in slight dorsiflexion, the trapezoid and the second metacarpal were reduced with a “clunk” sensation using longitudinal traction on the index finger and dorsal manipulation on the trapezoid body. Stabilization of the trapezoid and the second metacarpal was performed with 4 Kirschner wires. At 2 weeks postoperation, a radiograph confirmed reduction of the trapezoid and the second metacarpal. The patient remained splinted for 6 weeks, after which the wires were removed. Patient began rehabilitative active and passive hand and wrist motions. At 5-month follow-up, the patient was able to bend to 80° on his second CMC joint and to 110° on his other fingers with much improved hand and wrist function.

Awareness of carpal dislocation should be present when evaluating patients with high-energy traumatic injuries to the hand. The metacarpal cascade lines are useful for diagnosing CMC joint dislocations, and CT scans can help determine dislocation direction and confirm the diagnosis. Treatment requires ORIF, with most patients having a good prognosis.

Source: https://www.sciencedirect.com/science/article/pii/S235264402100008X?dgcid=rss_sd_all
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