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Case Reports
. 2019 Feb 15:20:100168.
doi: 10.1016/j.tcr.2019.100168. eCollection 2019 Apr.

A rare case of floating fifth metacarpal and review of literature

Furqan Mohammad Yaseen Khan  1 , Mohammad Reza Guity  1 , Arash Arfa  1 , Nima Bagheri  1
Affiliations
Case Reports

A rare case of floating fifth metacarpal and review of literature

Furqan Mohammad Yaseen Khan et al. Trauma Case Rep. .

Abstract

Background: Floating metacarpal is a rare concurrent bipolar dislocation of metacarpal at both ends. Isolated dislocations of Carpo-metacarpal (CMC) or Metacarpo-phalangeal (MCP) have been previously reported, simultaneous dislocations of both joints is scarcely reported in literature and bares high chance of diagnosis being missed on presentation.

Patient: A 29-year-old male presented with pain, swelling in left hand and loss of movement in fifth and fourth finger following a motorcycle fall injury. Radiography showed floating metacarpal of fifth ray along with fracture dislocation of at base of fourth metacarpal.

Diagnosis: The patient was diagnosed with floating fifth metacarpal along with fracture dislocation at base of fourth metacarpal.

Intervention: Open reduction and K-wire fixation was performed across CMC for fifth and fourth metacarpal along with MCP fixation for fifth metacarpal joint.

Outcomes: The patient had excellent outcome after one year with normal Range of motion and grip.

Lessons: Early recognition and prompt management of these injuries are considered as hallmark of prognosis. Ideal treatment for such dislocation is controversial. However, we have noted from earlier case reports that with acute dislocation and minimal swelling closed reduction and cast immobilization could be sufficient. In case of delayed presentation or swelling along with fracture, open reduction is favorable choice of treatment.

Keywords: CMC dislocation; Floating metacarpal; MCP dislocation.

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Figures

Fig. 1
Fig. 1
A:Anteroposterior(AP) & B: Lateral view of initial radiography.
Fig. 2
Fig. 2
A: Axial CT shows fracture of 4th metacarpal base (thick red arrow) B: sagittal CT indicates fracture and dislocation of 4th metacarpal base (thin red arrow) C: 3D reconstruction of hand CT scan. (For interpretation of the references to colour in this figure legend, the reader is referred to the web version of this article.)
Fig. 3
Fig. 3
A: AP & B: Lateral view of immediate post-operative X-ray.
Fig. 4
Fig. 4
A: Ap, B: Oblique, C: Lateral view of 1 year follow up.
Fig. 5
Fig. 5
ROM after 1 year shows no difference with contra-lateral side.
Fig. 6
Fig. 6
Suggested algorithm for treatment of floating metacarpal injuries.
See this image and copyright information in PMC

References

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    1. Rex C., Morris M., Dunkow P. Floating index metacarpal from double dislocation. Ind. J. Orthop. 2002;36(2):15.
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    1. Sakuma M., Inoue G. Simultaneous dorsal dislocation of the metacarpophalangeal and carpometacarpal joints of a finger. Arch. Orthop. Trauma Surg. 1998;117(4–5):286–287. - PubMed

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