Volar Carpometacarpal Dislocation Associated with Fracture of the Second, Third, and Fourth Metacarpal Bases Treated by Closed Reduction and Percutaneous Fixation: A Case Report.

INTRODUCTION: Volar dislocations of the carpometacarpal (CMC) joints are notably infrequent, attributable to the inherent stability afforded by their osseous morphology and robust volar ligamentous restrictions. When combined with fractures of two or more metacarpal bases, diagnosis and treatment may be delayed.

CASE REPORT: A 43-year-old male patient presented with volar dislocation of multiple CMC joints and metacarpal fractures, involving the bases of the second, third, and fourth metacarpals, subsequent to a low-energy fall from a bicycle. The injury was evaluated utilizing plain radiographs and computed tomography scanning. The patient was successfully managed with closed reduction and percutaneous Kirschner wire fixation, achieving stable anatomical fixation without requiring open reduction. Post-operative imaging demonstrated well-preserved reduction and stable fixation, with no neurovascular complications. At 10 weeks postoperatively, the patient demonstrated near-symmetric range of motion and excellent clinical satisfaction.

CONCLUSION: CMC fracture dislocations are injuries that can be missed, and a high index of suspicion is mandatory in severe swelling beyond the radiological findings. Early identification and immediate stabilization of unstable volar CMC fracture-dislocation lead to successful therapeutic outcomes. Closed reduction and percutaneous fixation result in lower morbidity and better recovery by preserving soft tissue, re-establishing joint congruity, and restoring optimal hand kinematics.