PMC7210917_01
The clinical presentation and radiological depiction of the injured left hand. (a) The index finger seen crossed over and resting on the dorsum of the third finger (rotational deformity). A bump noted over the dorsum of wrist (yellow arrow). (b) Anterior-posterior view showing the disparity in the parallelism between the second metacarpal-trapezoid and other carpometacarpal (CMC) articulations, break in the radiological M-line and asymmetrical orientation of the second metacarpal head tuberosity (blue arrow) indicating rotational deformity. (c) Lateral view: Discontinuity in the second CMC articulation with dorsal and proximal migration of base of the second metacarpal base.
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F1
On examination of the left hand (Fig. 1a), the index finger was appeared rotated and crossed over the dorsum of the middle finger. Plain radiographs of the left hand revealed a dislocation of metacarpal-trapezoidal joint with dorsal and proximal migration of the second metacarpal (Fig. 1b and c).
Computed tomography scan of the left hand. (a) 3D reconstructed picture. (b) Sagittal view - showing dislocation of the second metacarpal-trapezoid joint. (blue arrow) (c) Coronal view - no associated carpal or metacarpal injuries were observed.
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F2
The computed tomography (CT) scan of the left wrist revealed the same, and no associated carpal injuries were observed (Fig. 2a-c).
Post-reduction clinical and post stabilization radiographs. (a) complete resolution of deformities of the index finger and hand after closed reduction. (b) Anteroposterior view shows restoration of M line and symmetrical position of metacarpal head tuberosity, (c) oblique view, (d) lateral view. Concentric reduction observed on all views and stabilization of second metacarpal-trapezoid joint with 1.5 mm K-wire.
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F3
Under general anesthesia, a closed manipulation was attempted in the form of exaggerating the deformity and maneuvering a gentle distally directed force over the dislocated second metacarpal base which reduced with clunk and resolution of the deformities (Fig. 3a). The concentric reduction was attained and the articulation stabilized with a 1.5 mm Kirschner wire (K-wire) passed percutaneously under fluoroscopy guidance (Fig. 3b-d).