Open irreducible fracture/dislocation of the four ulnar metacarpals at the metacarpophalangeal joints: case report

Open irreducible fracture/dislocation of multiple metacarpophalangeal joints is an exceedingly rare injury and, to our knowledge, not yet described in the literature. An earlier belief that metacarpophalangeal dislocations were high-energy injuries is questioned by this case report due to an unusual case of open irreducible fracture/dislocation of the four ulnar metacarpals that occurred in a hand trauma. A 24-year-old man presented in the emergency department with an open irreducible fracture/dislocation of the four ulnar metacarpals and impaired flexion of the metacarpophalangeal joint of his left hand. The injury was described as an open injury of his third metacarpal head with an associated fracture of the fourth metacarpal head and dorsal dislocation of the four ulnar metacarpals after a fall onto the outstretched hand. Early recognition and anatomical reduction are essential to achieve good long-term outcomes. Massive edema, interposed volar ligaments, and overlapping metacarpal bases are the usual obstacles to a successful closed reduction. Use of a palmar approach was the key to reduce the displacement. Joint stability and osteosynthesis with K-wires were achieved, and the patient has been asymptomatic for more than 24 months.