Unrecognized Dislocation of the Hand—Stumbling Block While on Night Duty

A 40-year-old male patient presented to the emergency department during the night with pain in the right hand but no soft tissue injury following a fall from his bicycle. X-rays of the hand (PA/oblique) were initially found to be normal, and the swollen hand was immobilized with a forearm splint as a first step. Due to persisting discomfort, a strictly lateral X-ray was ordered, which showed dislocation of the 4^th and 5^th carpometacarpal joints. Thin-slice computed tomography confirmed 4^th/5^th carpometacarpal dislocation with a fracture of the hamate bone. Surgical treatment was then promptly performed. With a frequency of <1% of all hand injuries, we believe that carpometacarpal dislocations and dislocation fractures often go unrecognized even by experienced physicians on standard X-rays in two planes during initial treatment in a busy emergency department. Signs such as apparent shortening of finger rays or inability to discern the carpometacarpal joint space on the PA image point to dislocation of the carpometacarpal joints and should prompt investigation using thin-slice CT. The subsequent lateral X-ray indicated the injury by the axial deviation of the metacarpal bones and the dislocation of the metacarpal base.

Figure

Hand X-ray

PD Dr. med. Marcus Spies, Dr. Felix Rockmann, Klinik für Plastische, Hand- und wiederherstellende Chirurgie, Barmherzige Brüder Regensburg, [e-mail]

Conflict of interest statement:The authors state that no conflict of interest exists.

Translated from the original German by Christine Rye.

Cite this as: Spies M, Rockmann F: Unrecognized dislocation of the hand—a stumbling block while on night duty. Dtsch Arztebl Int 2024; 121: 600. DOI: 10.3238/arztebl.m2024.0109