PMC6864321_01
Pre-operative X-ray (lateral view).. X-ray demonstrate a posterior dislocation of the 4th and 5th metacarpal bases in CMC joint, with fractured tiny bone fragments in the ventral side of the CMC joint.
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Computed tomography (CT) and X-ray was performed and diagnosed as posterior dislocation of 4th and 5th metacarpal bases in the carpometacarpal joints (CMCJ) and fractured tiny bone fragments are found in the ventral side of CMC joint (Fig. 1).
Intra-operative, immediate post-operative X-ray.. Although closed reduction was attempted, the CMC joints were unstable. Following our protocol, reduction was obtained by longitudinal traction and lateral pressure on the displaced bone and fixation with a transarticular pin and transfixation pins into the adjacent metacarpal was planned. During these procedures, the resident of our team made several attempts to insert transfixation pins with 1.1 mm K-wire into the metacarpal shaft, but each attempt failed. After final fixation, immediate postoperative X-ray showed the K-wire tracks (Yellow Circle).
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Radiologic finding demonstrated incorrect placement of the K-wire track (Fig. 2), however we think it will be healed and union with splinting.
Simple X-ray at five weeks postoperatively.. Simple X-ray of his hand demonstrated the union of the fractured site but the K-wire track still showed with no signs of displacement.
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Although the K-wire track still showed, there were no signs of displacement (Fig. 3).
Iatrogenic fracture developed following failed K-wire tracks.. Two weeks later, the patient came back with acute onset of pain and swelling at the 5th metacarpal area. A radiograph of his hand was performed, which demonstrated a fracture through the metacarpal shaft where the K-wire had failed to enter the bone.
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A radiograph of his hand was performed, which demonstrated a fracture through the metacarpal shaft where the K-wire had failed to enter the bone (Fig. 4).
Simple X-ray (AP view (left) and oblique view (right) Postoperative 8 weeks.. Initial CMC dislocation and fracture was well healed, however displacement of fracture on metacarpal body caused by secondary fracture is aggravated and malunion was suspected.
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However, displacement is aggravated and malunion is suspected (Fig. 5).