What’s the Diagnosis – Case 68
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Findings/Diagnosis On the radiographs there is an overlap of the base of the fifth metacarpal (MC) and hamate seen on the frontal and oblique views. There is subtle bony fragmentation seen at this location. The CT images much more clearly delineate the dorsal dislocation and proximal migration of the fifth metacarpal as well as a distracted and comminuted fracture of the hamate. There is a much more subtle fracture seen at the base of the fifth metacarpal.
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Diagnosis: 5th Metacarpal fracture dislocation/reverse Bennett fracture
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This injury can be difficult to diagnose on radiographs and frequently can only be identified by the overlap of the bones at the joint on frontal or oblique views. The remainder of the digits limit ability to see the dislocation on the lateral view. By in large these injuries occur in men and are either from sports, MVA, or trauma/fights and typically are related to an axial load imparted to the wrist.
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The proximal migration and dorsal dislocation of the metacarpal is related to a pull from the extensor carpi ulnaris as its insertion is at the base of the 5th MC. As in this case, the injuries typically are unstable and require surgical intervention with fixation.
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Resources •
http://www.wheelessonline.com/ortho/carpometacarpal_fracture_dislocation
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http://emedicine.medscape.com/article/1287549-overview
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