Visual diagnosis in emergency medicine| Volume 20, ISSUE 3, P295-296, April 2001

Total metacarpal dislocation

      A 47-year-old man presented to the Emergency Department 4.5 h after sustaining a hand injury from punching a refrigerator while intoxicated. He complained of hand pain but no numbness or tingling. On examination, the right hand was grossly deformed (Figure 1 ) with mild edema of the carpus. Motor and sensory function of the fingers were intact, and the fingers were warm, with normal capillary refilling time. The X-ray studies of the hand (Figure 2, Figure 3) revealed dorsal dislocation of the index through little finger metacarpals off of the carpal row with small, avulsed bone fragments adjacent to the distal row of carpals.
      Figure thumbnail GR1
      Figure 1Hand injury sustained by punching a non-deformable surface.
      Figure thumbnail GR2
      Figure 2Antero-posterior X-ray of the right hand demonstrating carpo-metacarpal dislocation. Arrow indicates the abnormal overlapping of the carpal and metacarpal bones.
      Figure thumbnail GR3
      Figure 3Lateral X-ray of the hand demonstrating dorsal dislocation of the index through little finger metacarpals. Arrow indicates fracture fragments.
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