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Floating Thumb with Simultaneous Carpometacarpal and Metacarpo-phalangeal Dislocation: A Case Report

Received: 17 February 2019     Accepted: 2 April 2019     Published: 22 April 2019
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Abstract

Double dislocation of carpometacarpal and metacarpo-phalangeal joints of thumb is also called ‘floating thumb metacarpal’. This rare injury usually presents with combined joints dislocation and collateral ligaments rupture, which may be predisposing to joint instability after closed reduction. We report a case of traumatic and chronic dislocation of carpometacarpal and metacarpo-phalangeal joints of left thumb in a 63-year-old housewife. Failure of non-operative treatment was found up to 1 month after injury due to missed follow-up. Closed reduction was tried but failed because of joints stiffness. Open reduction and K-wire fixation were performed and radial collateral ligaments were repaired. Patient restored good functional outcome with no evidence of arthritis or subluxation at 1 year. Open reduction and fixation show good result in our case with delayed surgical intervention. The management of a floating thumb could be non-operative by close reduction and cast immobilization. However, closed monitoring and regular follow-up are critical after non-operative treatment to avoid potential risk of post-operative complications.

Published in Journal of Surgery (Volume 7, Issue 1)
DOI 10.11648/j.js.20190701.15
Page(s) 24-27
Creative Commons

This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.

Copyright

Copyright © The Author(s), 2019. Published by Science Publishing Group

Keywords

Double Dislocation of Carpometacarpal and Metacarpo-Phalangeal, Floating Thumb, Carpometacarpal, Metacarpo-Phalangeal

References
[1] Drosos, G., E. Kayias, and K. Tsioros, "Floating thumb metacarpal" or complete dislocation of the thumb metacarpal: a case report and review of the literature. Injury, 2004. 35(5): p. 545-8.
[2] KS, S., et al., Simultaneous dislocation of the carpometacarpal and metacarpophalangeal joints of the thumb in a motorcyclist. Journal of the Formosan Medical Association = Taiwan yi zhi, 2006. 105(8): p. 670-3.
[3] Couceiro, J., et al., Thumb carpometacarpal dislocation and open dorsal metacarpophalangeal instability: a variation of the floating thumb. Arch Plast Surg, 2014. 41(2): p. 190-2.
[4] HR, T., et al., Traumatic Floating 1st Metacarpal in a 14-Year-Old Boy Managed by Close Reduction and Thumb Spica Immobilization: A Rare Case Report. 2014. 4(4): p. 44-7.
[5] Messaoudi, T., et al., Floating thumb metacarpal in a motorcyclist: A case report. Chirurgie de la main, 2015. 34(2): p. 91-93.
[6] Ibrahim, S. and M. Noor, Simultaneous dislocations of the carpometacarpal and metacarpophalangeal joints of the thumb. Injury, 1993. 24(5): p. 343-4.
[7] Rajeev, A., S. Noureldin, and D. Graham, Floating thumb with double dislocation of carpometacarpal and metacarpo-phalangeal joints. Int J Surg Case Rep, 2014. 5(12): p. 1102-5.
[8] Gerard, F., Y. Tropet, and L. Obert, Trapezo-metacarpal and metacarpo-phalangeal dislocation of the thumb associated with a carpo-metacarpal dislocation of the four fingers. Chir Main, 1999. 18(3): p. 205-8.
[9] Khan, H., P. Darcy, and P. Magnussen, Simultaneous Volar Dislocations of Carpometacarpal and Metacarpophalangeal Joints of the Thumb. J Orthop Case Rep, 2012. 2(3): p. 8-11.
[10] Moore, J., C. Webb, and R. Thompson, A complete dislocation of the thumb metacarpal. J Hand Surg Am, 1978. 3(6): p. 547-9.
[11] Marcotte, A. and M. Trzeciak, Nonoperative treatment for a double dislocation of the thumb metacarpal: a case report. Arch Orthop Trauma Surg, 2008. 128(3): p. 281-4.
[12] Sakuma, M. and G. Inoue, Simultaneous dorsal dislocation of the metacarpophalangeal and carpometacarpal joints of a finger. Arch Orthop Trauma Surg, 1998. 117(4-5): p. 286-7.
Cite This Article
  • APA Style

    Xiang Li, Frankie Leung, Christian Fang, Tak Man Wong. (2019). Floating Thumb with Simultaneous Carpometacarpal and Metacarpo-phalangeal Dislocation: A Case Report. Journal of Surgery, 7(1), 24-27. https://doi.org/10.11648/j.js.20190701.15

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    ACS Style

    Xiang Li; Frankie Leung; Christian Fang; Tak Man Wong. Floating Thumb with Simultaneous Carpometacarpal and Metacarpo-phalangeal Dislocation: A Case Report. J. Surg. 2019, 7(1), 24-27. doi: 10.11648/j.js.20190701.15

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    AMA Style

    Xiang Li, Frankie Leung, Christian Fang, Tak Man Wong. Floating Thumb with Simultaneous Carpometacarpal and Metacarpo-phalangeal Dislocation: A Case Report. J Surg. 2019;7(1):24-27. doi: 10.11648/j.js.20190701.15

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  • @article{10.11648/j.js.20190701.15,
      author = {Xiang Li and Frankie Leung and Christian Fang and Tak Man Wong},
      title = {Floating Thumb with Simultaneous Carpometacarpal and Metacarpo-phalangeal Dislocation: A Case Report},
      journal = {Journal of Surgery},
      volume = {7},
      number = {1},
      pages = {24-27},
      doi = {10.11648/j.js.20190701.15},
      url = {https://doi.org/10.11648/j.js.20190701.15},
      eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.js.20190701.15},
      abstract = {Double dislocation of carpometacarpal and metacarpo-phalangeal joints of thumb is also called ‘floating thumb metacarpal’. This rare injury usually presents with combined joints dislocation and collateral ligaments rupture, which may be predisposing to joint instability after closed reduction. We report a case of traumatic and chronic dislocation of carpometacarpal and metacarpo-phalangeal joints of left thumb in a 63-year-old housewife. Failure of non-operative treatment was found up to 1 month after injury due to missed follow-up. Closed reduction was tried but failed because of joints stiffness. Open reduction and K-wire fixation were performed and radial collateral ligaments were repaired. Patient restored good functional outcome with no evidence of arthritis or subluxation at 1 year. Open reduction and fixation show good result in our case with delayed surgical intervention. The management of a floating thumb could be non-operative by close reduction and cast immobilization. However, closed monitoring and regular follow-up are critical after non-operative treatment to avoid potential risk of post-operative complications.},
     year = {2019}
    }
    

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    T1  - Floating Thumb with Simultaneous Carpometacarpal and Metacarpo-phalangeal Dislocation: A Case Report
    AU  - Xiang Li
    AU  - Frankie Leung
    AU  - Christian Fang
    AU  - Tak Man Wong
    Y1  - 2019/04/22
    PY  - 2019
    N1  - https://doi.org/10.11648/j.js.20190701.15
    DO  - 10.11648/j.js.20190701.15
    T2  - Journal of Surgery
    JF  - Journal of Surgery
    JO  - Journal of Surgery
    SP  - 24
    EP  - 27
    PB  - Science Publishing Group
    SN  - 2330-0930
    UR  - https://doi.org/10.11648/j.js.20190701.15
    AB  - Double dislocation of carpometacarpal and metacarpo-phalangeal joints of thumb is also called ‘floating thumb metacarpal’. This rare injury usually presents with combined joints dislocation and collateral ligaments rupture, which may be predisposing to joint instability after closed reduction. We report a case of traumatic and chronic dislocation of carpometacarpal and metacarpo-phalangeal joints of left thumb in a 63-year-old housewife. Failure of non-operative treatment was found up to 1 month after injury due to missed follow-up. Closed reduction was tried but failed because of joints stiffness. Open reduction and K-wire fixation were performed and radial collateral ligaments were repaired. Patient restored good functional outcome with no evidence of arthritis or subluxation at 1 year. Open reduction and fixation show good result in our case with delayed surgical intervention. The management of a floating thumb could be non-operative by close reduction and cast immobilization. However, closed monitoring and regular follow-up are critical after non-operative treatment to avoid potential risk of post-operative complications.
    VL  - 7
    IS  - 1
    ER  - 

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Author Information
  • Shenzhen Key Laboratory for Innovative Technology in Orthopaedic Trauma, Department of Orthopaedics and Traumatology, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China

  • Shenzhen Key Laboratory for Innovative Technology in Orthopaedic Trauma, Department of Orthopaedics and Traumatology, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China

  • Shenzhen Key Laboratory for Innovative Technology in Orthopaedic Trauma, Department of Orthopaedics and Traumatology, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China

  • Shenzhen Key Laboratory for Innovative Technology in Orthopaedic Trauma, Department of Orthopaedics and Traumatology, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China

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