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Objective: We present the treatment of an uncommon type of injury in a high energy trauma and we report our approach and results.Case: A 28 years old male patient admitted in our hospital after a high energy, motor vehicle accident with multiple injuries.The patient had abdominal bleeding, anterior shoulder dislocation, a subtrochanteric fracture on the right hip and complex ligament instability of the left knee with PLC, ACL, LCL and MCL tear.On the right hand he had fracture of the proximal phalanx of the index finger, dorsal dislocation of the 2nd-5th CMCJ and also fractures of the hamate and trapezium.The patient has been treated with multiple medical treatments such as embolization of a branch of the right deep femoral artery, laparotomy, splenectomy, femoral osteosynthesis with a long Gama IM nail for the right proximal femur fracture and closed reduction for the carpometacarpal dislocations right hand and closed reduction of shoulder dislocation.A few days later he has been transferred to theatre again for definite treatment of the right hand fractures with closed reduction and percutaneously K-wire fixation.Treatment of the PLC injury of the left knee followed a few days later, revealed tear of the common peroneal nerve so referred for common peroneal nerve repair with sural nerve graft.The K-wires stayed in situ for 8 weeks for the CMC dislocations and for 4 weeks for the proximal phalanx fracture and removed in the clinic.A futuro splint applied for further 2 weeks and the patient started physiotherapy for his right hand.Six months post his injury the patient presents excellent functional recovery of his hand.His DASH score gradually improved from 30, 3 months post injury, to 1,66 in 6 months after intensive physiotherapy. Conclusion:Fracture dislocations of the multiple carpometacarpal joints of the fingers can be part of major high energy trauma with multiple, life threatening, injuries and can be missed as the major injuries can take all the attention.This injury can be associated with other fractures of the wrist and the hand such as with trapezium, hamate and proximal phalanx.We treated this injury with closed reduction and percutaneously K-wire fixation.This treatment can provide satisfactory results with excellent functional outcome and patient satisfaction.
Apostolou et al. (Sat,) studied this question.