Simultaneus dislocation of the carpometacarpal and metacarpophalangeal joint, a case report

1. Simultaneus dislocation of the
carpometacarpal and
metacarpophalangeal joint
„Floating thumb“
Clinic for Orthopaedic Surgery and
traumatology,
Clinical centre of Vojvodina,
Novi Sad, Serbia
OMI - Seminar „Bone & Joint Surgery“
22-28 January 2017
Miodrag Vranješ, MD

2. History and physical examination
 58 year old female, fall on the outstretched hand
 In the ER she complains of pain and limited ROM of her right thumb
 On examination there is pain on palpation, mild swelling,
deformation and no signs of neurovascular compromise
 Right hand dominant
 Unemployed
Day 3

3. Pre-operative Imaging

4. Pre-operative Imaging (closed reduction failed)

5. Pre-operative Imaging (МRI)
CMC joint
 Palmar sided small
intraarticular first MC base
fracture
 Partial rupture of ulnar
collateral ligament
 Rupture od anterior and
posterior oblique ligament
 Rupture of intermetacarpal
ligament
MCP joint
 Partial rupture of volar plate
 Partial ruputre of ulnar and
complete rupture od radial
collateral ligament

6. Operative technique (day 15)
 Regional anesthesia
(axillary block)
 Supine position
 Hand on radiolucent
table
 Tourniquet
CMC joint
 Closed reduction & K
wire fixation
MCP joint
 Dorsal-Radial
approach
 Reduction and suture
of radial collateral
ligament and capsule
 Extraction od K wires
after 6 weeks, rehab

7. Outcome (4,5 months)
 No pain, primarly healing of wound, not full grip strenght, slight
limitation of ROM but could perform opposition of the thumb pulp
to pulps of all other digits
 Patient overall satisfied
 Quick DASH score: 18.2

8. Questions
 What is the metod of treatment you would recommend?
 Are sutures with 1.3 mm bone anchors really necessary?
 Will she develop arthritis of the CMC joint?
Thank you for your attention