Trapeziometacarpal Dislocations in Pediatric Age, Is There a Better Treatment? Series of Cases and a Systematic Review

Abstract

(1) Background: Dislocations of the trapeziometacarpal joint (TMC) are uncommon in children and adolescents. Only a few isolated cases are reported in the literature. Therapeutic guidance is minimal and inconclusive. (2) Methods: The authors present four patients treated for this unusual lesion. We evaluated the evolution according to treatment, age, patient activity, and quickDASH. Despite the clear limitation of the small number of patients, it is relevant to try to better understand this lesion and its evolution. A systematic review of the literature was also conducted. (3) Results: This is the largest published series of TMC dislocations in children and adolescents. Patients included a 12-year-old girl treated conservatively with a poor quickDASH; a 9-year-old girl treated surgically with the Eaton-Littler technique for a new dislocation with a partially modified quickDASH; a 13-year-old boy with two necessary closed reductions for a new dislocation and a very good final quickDASH; and a 12-year-old boy treated with closed reduction and percutaneous fixation with excellent final results with quickDASH. (4) Conclusions: In the absence of scientific evidence, conservative treatment and ligament reconstruction did not provide good functionality. In contrast, closed reduction with percutaneous fixation provided excellent results. Therefore, the authors would recommend closed reduction and percutaneous needle fixation as an elective method to treat TMC dislocations in pediatric and adolescent patients.

Keywords: adolescent; carpometacarpal joints; cast; child; closed fracture reduction; joint dislocations; recurrence; surgery; surgical; thumb; trapezoid bone.

Figure 1

Anatomical dissection of the ligamentous structures of the TMC joint. Author: Enric Dominguez-Font. (a) Dorsal view of the dorsal ligament group of the TMC joint: (A) dorsoradial ligament (DRL), (B) dorsocentral ligament (DCL), and (C) posterior oblique ligament (POL). (b) Volar view of the volar ligament group of the TMC joint: (F) anterior oblique ligament (AOL) and (G) ulnar colateral ligament (UCL). (c) Dorsal view of the ulnar ligament group of the TMC joint: (D) dorsal trapeciometacarpal ligament (dTMCL) and (E) intermetacarpal ligament (IML).

Figure 2

Plain radiographs of the TMC joint. (a) Roberts projection—strict AP view of the TMC joint. (b) Lateral view of the TMC joint.

Figure 3

(a,b) acute TMC joint dislocation.

Figure 4

X-ray views of TMC joint after closed reduction. (a) AP view. (b) Lateral view.

Figure 5

(a,b): CT was performed at two weeks (Figure 4), showing good joint congruency and no associated fractures.

Figure 6

(a,b): Relapse with articular subluxation two weeks after closed reduction.

Figure 7

Patient referred from another center in the subacute phase.

Figure 8

Closed reduction and percutaneous K-wire fixation.