Kamble Prashant, Prabhu Rudra Mangesh, Mohanty Shubhranshu S, Ariwala Dipen, Yadav Vinod Kumar
Department of Orthopaedics, Seth GS Medical College and KEM Hospital, Mumbai, Maharashtra, India.
J Orthop Case Rep. 2022 Dec;12(12):109-113. doi: 10.13107/jocr.2022.v12.i12.3486.
Dislocation of the carpometacarpal (CMC) joint is a rare injury that results following high-velocity trauma. Although there are a few anecdotal reports of isolated CMC joint dislocations, there is scarce literature concerning dislocations involving multiple joints, especially those that are neglected and present late after injury. The injury is often missed when the patient presents to the surgeon since the swelling obscures the characteristic deformity, and the fracture may not be apparent on radiographs. When missed at the initial presentation, they can frequently result in pain, swelling, reduced grip strength, and arthritis. Such injuries require surgical management, along with prompt post-operative physiotherapy to enable the patient to regain satisfactory grip strength and range of motion.
We retrospectively analyzed four cases of multiple CMC joint dislocations that were managed surgically at our tertiary apex center. The average duration between injury and presentation to our center was five weeks. We used the quick disabilities of the arm, shoulder, and hand (DASH) scores and the maximum handgrip strength to assess the functional outcomes and the visual analog scale (VAS) to assess the pain at regular intervals. All patients showed an improvement in the Quick DASH scores, VAS scores, and the handgrip strength at the latest follow-up. All patients were able to return to their occupation.
Early diagnosis and stabilization followed by early mobilization is the key to managing multiple CMC dislocations. The cases that present late are generally associated with contracted soft-tissue structures that prevent the relocation of the injury. Such cases require open reduction, along with a release of the contracted structures and internal fixation. Supervised physiotherapy in the post-operative period is essential to regain a satisfactory range of motion and grip strength.
腕掌关节（CMC）脱位是一种因高速创伤导致的罕见损伤。尽管有一些关于孤立性CMC关节脱位的零星报道，但关于涉及多个关节的脱位，尤其是那些被忽视且伤后就诊较晚的病例的文献却很匮乏。当患者就诊于外科医生时，这种损伤常被漏诊，因为肿胀掩盖了特征性畸形，而且骨折在X线片上可能不明显。如果在初次就诊时漏诊，它们常常会导致疼痛、肿胀、握力下降和关节炎。此类损伤需要手术治疗，并及时进行术后物理治疗，以使患者恢复满意的握力和活动范围。
我们回顾性分析了在我们的三级顶尖中心接受手术治疗的4例多发性CMC关节脱位病例。受伤至来我院就诊的平均时间为5周。我们使用手臂、肩部和手部快速残疾评估量表（DASH）评分和最大握力来评估功能结果，并使用视觉模拟量表（VAS）定期评估疼痛情况。在最近一次随访时，所有患者的快速DASH评分、VAS评分和握力均有改善。所有患者都能够重返工作岗位。
早期诊断、复位并尽早进行活动是处理多发性CMC脱位的关键。就诊较晚的病例通常伴有软组织挛缩，这会阻碍损伤部位的复位。此类病例需要切开复位，同时松解挛缩结构并进行内固定。术后在监督下进行物理治疗对于恢复满意的活动范围和握力至关重要。
