Vol 44 # 4 December 2012 - Kma.org.kw

December 2012
KUWAIT MEDICAL JOURNAL 342
Fig. 1: (A) Initial X-rays showing dorsal dislocation of ulnar four metacarpal bases with overlapping of joint surfaces; (B) Lateral X-ray
showing dorsal offset of metacarpal complex; (C) postoperative radiograph showing satisfactory reduction and stabilization of joint with
multiple Kirschner wires
Fig. 2: (A) Radiograph at four weeks post injury after removal of K-wire showing satisfactory healing and congruent reduction of joint
surfaces; (B) Post-rehabilitation photographs showing gradual improvement in hand function from four weeks to eight weeks
revealing antero-posterior and oblique radiographs of
hand, gross swelling of hand are incriminating factors.
Literature also suggests repeated mistakes with this
diagnosis even by experts [3] .
Multiple CMC dislocations are often a high energy
trauma often occurring in motorcyclists and boxers.
Deduced pathway of injury appears to be forceful
impact on metacarpal bases with a closed fist [5] . The
patient will often have a diffuse swelling of dorsum of
hand and distal forearm. It may be fluctuant depicting
a hematoma collection. The characteristic hump of
dislocation at root of hand is often masked by swelling
of hand and forearm.
Routinely ordered X-rays in antero-posterior
and oblique plane suggest the diagnosis. Lateral
projection radiograph will confirm the multiple CMC
dislocations in suspicious cases [6] . Often dislocation
is dorsal. There can be associated fracture of adjacent
carpal or metacarpal bones. The clues for such an
obscure diagnosis are loss of parallelism between joint
spaces at base of metacarpals and carpals. There will
be an overlap of joint surfaces of base of metacarpals
over carpus. There can be appreciable offset of fifth
metacarpal base as in our case [3,7] . A lateral radiograph
will affirm the misalignments of metacarpals over
carpus.