A Rare Case of Multiple Carpometacarpal Joint Fracture-Dislocations with Fractures of the Hamate and Capitate.

INTRODUCTION

Carpometacarpal (CMC) joint dislocations and fracture-dislocations are infrequent and often challenging to diagnose. Among these, dorsal fracture-dislocations involving the capitate and third metacarpal, as well as the hamate with the fourth and fifth metacarpals, represent an exceptionally rare subset. These injuries are typically the result of high-energy mechanisms, such as axial loading transmitted through a clenched fist striking a solid surface. Their subtle clinical signs and often inconspicuous radiographic findings, particularly in the context of polytrauma, contribute to a high rate of missed or delayed diagnoses. This paper aims to highlight the diagnostic challenges and management considerations of these rare dorsal CMC fracture-dislocations, emphasizing the importance of clinical suspicion and appropriate imaging in ensuring timely and effective treatment.

CASE PRESENTATION: We report a rare case of dorsal fracture-dislocation involving the capitate-third metacarpal and hamate-fourth/ fifth metacarpal joints. The patient sustained the injury following blunt force trauma consistent with a clenched-fist mechanism. Definitive diagnosis was made following advanced imaging, which guided successful surgical management using open reduction and internal fixation of the hamate, capitate as well as the third and fourth CMC joints with excellent post-operative result and range of motion.

CONCLUSION

Dorsal fracture-dislocations of the capitate-third and hamate-fourth/fifth metacarpal joints are rare but potentially debilitating. Early recognition through careful clinical evaluation and targeted imaging is critical to prevent chronic pain, stiffness, and impaired hand function.