First carpal-metacarpal joint dislocation and trapezial fracture treated with external fixation in an adolescent.

The intrinsic joint stability of the first carpal-metacarpal joint (CMC) makes dislocation a rare injury with fewer than 40 cases described. The degree to which supporting ligaments have been disrupted is reflected clinically by a spectrum of joint stability. Close review of radiographs and an attentive physical examination are necessary to make the diagnosis. Acute treatment has consisted of closed or open reduction with K-wires for stabilization or casting with failures leading to chronic joint instability and the need for soft tissue tendon suspension to maintain joint alignment. We present the case of a 12-year-old boy with a complete first CMC dislocation and trapezial fracture treated with closed reduction and external fixation. At a 3-year follow-up, our patient demonstrates excellent range of motion, strength, and no joint instability without functional limitations. We suggest that external fixation be added to the armamentarium for managing these difficult injuries especially in the pediatric population where interference with growth plates is not ideal.