PMC5612027_01
Edema and swelling of the hand with the presence of an important laceration at a thenar level.
TOORTHJ-11-1035_F1.jpg
PMC5612027_01_TOORTHJ-11-1035_F1.jpg
F1
In the physical examination, pain and a functional impotence of the hand at 45o was identified, with the presence of a blunt laceration at a thenar level (Figs. 1a, b).
Postinjury radiographs (anteroposterior, lateral, and oblique views) showing volar and radial dislocation of the second, third, and fourth carpometacarpal joints.
TOORTHJ-11-1035_F2.jpg
PMC5612027_01_TOORTHJ-11-1035_F2.jpg
F2
This evidenced a radio volar dislocation on the second, third and fourth carpometacarpal joints, linked with a Bennett's fracture of the first finger (Figs. 2a, b, c).
In this intra-operative image there can be seen the preservation of the superficial palmar arch of the hand which seems integral and uninjured.
TOORTHJ-11-1035_F3A.jpg
PMC5612027_01_TOORTHJ-11-1035_F3A.jpg
F3a
The integrity of the superficial palmar arch and the rest of tendon structures present on that level were identified (Fig. 3a). Afterwards, the other wires were also fixed: one transversally and two longitudinally, following the axis of the central metacarpals Fig. 3b. The post-operative radiographs showed the reduced second, third, and fourth carpometacarpal joints stabilized with Kirschner wires (Fig. 3c).
Radiological intra-operative image in which there can be seen the disposition of the Kirschner wires: one of them oblique from the base of the first to the second metacarpal, another transversally and two longitudinally following the axis of the central metacarpals.
TOORTHJ-11-1035_F3B.jpg
PMC5612027_01_TOORTHJ-11-1035_F3B.jpg
F3b
The wounds exhibited correct healing (Figs. 4a, b) and eight weeks later the patient was able to move his fingers without pain and with a strength comparable to that of the other hand.