Isolated thumb carpometacarpal (CMC) joint dislocation is a rare injury pattern with many treatment options described in literature. However, the optimal treatment option is still controversial.
A 62-year-old female patient presented to hospital with an isolated dorsal dislocation of the thumb CMC joint after a fall. Closed reduction of the dislocation was successfully reduced but joint was grossly unstable all directions and redislocated. Reconstruction of ruptured dorsoradial ligament (DRL) with Extensor Carpi Radialis Longus (ECRL) autograft was done. The torn capsule was repaired in an end-to-end fashion and immobilization with Kirschner wires (K-wires) fixation and thumb spica splint was done for 6 weeks.
At 1 year follow-up evaluation, the patient was pain free and returned to her previous level of activity. No restriction of carpometacarpal movements or residual instability was noticed. The postoperative pinch and grip strength was equivalent to 77% and 70% of the contralateral hand, respectively. The Kapandji score was 9.Radiographic examination showed normal joint congruity and no signs of subluxation or early osteoarthritis.
Surgical stabilization of dorsal capsuloligamentous complex with ECRL autograft for DRL reconstruction may be considered the selected treatment option in unstable acute traumatic dislocation of thumb CMC joint in young and high demand patients which aims to restore stability, improve functional outcomes, and prevent long-term complications. With successful surgery and diligent rehabilitation, patients can expect significant improvements in grip strength, pinch strength, and the Kapandji score, leading to enhanced overall hand function.
