Case Report
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Oct 6, 2023; 11(28): 6871-6876
Published online Oct 6, 2023. doi: 10.12998/wjcc.v11.i28.6871
Dorsal approach for isolated volar fracture-dislocation of the base of the second metacarpal: A case report
Taketo Kurozumi, Masato Saito, Kazuhiko Odachi, Fumiaki Masui
Taketo Kurozumi, Trauma Center, Toranomon Hospital, Tokyo 105-8470, Japan
Taketo Kurozumi, Masato Saito, Kazuhiko Odachi, Fumiaki Masui, Department of Orthopedic Surgery, Chiba-Nishi General Hospital, Chiba 270-2251, Japan
Author contributions: Kurozumi T analyzed the case and wrote the manuscript; Saito M, Odachi K and Masui F contributed equally to this work; All authors have read and approve the final manuscript.
Informed consent statement: The patient was informed that data from the case would be submitted for publication and they provided their consent.
Conflict-of-interest statement: All the authors declare that they have no conflict of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Taketo Kurozumi, MD, PhD, Director, Trauma Center, Toranomon Hospital, 2-2-2, Toranomon, Minato, Tokyo 105-8470, Japan. taketo_kurozumi@m6.dion.ne.jp
Received: June 17, 2023
Peer-review started: June 17, 2023
First decision: August 24, 2023
Revised: September 2, 2023
Accepted: September 11, 2023
Article in press: September 11, 2023
Published online: October 6, 2023
Processing time: 100 Days and 3.7 Hours
Abstract
BACKGROUND

We report a case with the displacement of an articular fracture fragment of the base of the second metacarpal from the ulnar to the volar side, treated via the dorsal approach. The dorsal approach can be a good option not only because it allows direct observation of ligament damage and fixation of bone fragments but also because the thin subcutaneous tissue makes the approach easier.

CASE SUMMARY

A 45-year-old man with a right hand injury visited the hospital. A small bone fragment was identified using plain radiography. Lateral radiography revealed the fragment as lying over the volar aspect of the carpometacarpal (CMC) joint. Computed tomography revealed that approximately one-third of the CMC joint surface of the second metacarpal was damaged. We provisionally diagnosed an intra-articular fracture with significant CMC joint instability and performed open reduction and internal fixation. We made a dorsal longitudinal incision over the CMC joint between the second and third metacarpals. The dorsal ligament of the third CMC joint was torn. We thought it had been dislocated to the volar side and spontaneously reduced to that position. There are only few reports of volar dislocation of CMC joint fractures, particularly of the second and third metacarpals; our report is unique as our patient had an intact interosseous ligament between the second and third metacarpals.

CONCLUSION

Although past reports have used a palmar approach, the dorsal approach is a good option for these cases.

Keywords: Metacarpal bone; Fracture-dislocation; Mechanism; Dorsal approach; Carpometacarpal joint; Case report

Core Tip: We report a case of displacement of an articular fracture fragment from the base of the second metacarpal from the ulnar to the volar side, treated via the dorsal approach. The dislocation mechanism was different from that in previously reported cases. The dorsal approach is a good option not only because it allows direct observation of ligament damage and fixation of bone fragments but also because the thin subcutaneous tissue makes the approach easier.