Dislocations and Ligament Injuries of the Hand-Case: Dislocations and Ligament Injuries of the Hand

Case: Dislocations and Ligament Injuries of the Hand

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The document discusses two cases of hand ligament injuries and dislocations. <br /><br />In the first case, a 33-year-old man presented to the emergency room (ER) with pain in his right hand after punching a wall. Physical examination revealed swelling and tenderness in the dorsal hand, but the skin was intact. Short-arc flexion and extension of the thumb and fingers were performed, and neurovascular status was normal. X-rays showed dorsal dislocations of the 2nd, 3rd, 4th, and 5th carpometacarpal joints, as well as a fractured hook of the hamate and comminuted dorsal trapezoid. The management consisted of closed reduction and percutaneous pinning in the operating room using K-wires, while the hamate and trapezoid fractures were not instrumented. The hand was protected with a splint and early motion of uninvolved joints was encouraged. The pins were removed after 6 weeks.<br /><br />In the second case, a 42-year-old man was involved in a motor vehicle accident where his hand was struck by the expanding airbag of his vehicle. He presented to the ER with right thumb pain and deformity. On examination, there was a laceration at the volar base of the thumb with swelling and tenderness. X-rays revealed an intraarticular fracture of the thumb proximal phalanx base and an extraarticular fracture of the thumb metacarpal base. The management included closed reduction and percutaneous pinning in the operating room. The intraarticular fracture was fixed with small wires, and the extraarticular fracture was fixed with 0.062 K-wires directed into the trapezium for additional stability. The thumb was protected with a splint and early motion of uninvolved joints was encouraged. The pins were removed after 6 weeks.<br /><br />In both cases, surgical intervention was necessary due to the instability of the injuries. Close monitoring and appropriate management are crucial for optimal recovery and function of the hand.

Keywords

hand ligament injuries

hand dislocations

emergency room

dorsal hand swelling

closed reduction

percutaneous pinning

fractured hook of the hamate

comminuted dorsal trapezoid

intraarticular fracture

extraarticular fracture