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Paediatric trapeziometacarpal dislocation: a case report

Traumatic trapeziometacarpal (TMC) dislocation without a fracture is an uncommon injury in adults and exceptionally rare in children (McCarthy and Awan, 2014; Nusem et al., 2001). We report the case of a 10-year-old girl who sustained a left thumb injury. On examination 3 days later, left thumb examination showed a reducible dislocated thumb metacarpal base. The contralateral TMC joint was stable. General examination showed some joint laxity, scoring 6 on the Beighton grade. Radiographs revealed dorsolateral TMC dislocation (Figure 1(a)). Application of a thumb spica cast was unsuccessful at maintaining joint reduction. Consequently, the patient subsequently underwent closed reduction and percutaneous pinning with a 1.5 mm K-wire (Figure 1(b)). A thumb-spica cast was then applied, with the cast and wire removed 6 weeks later. At review after 1 year, the patient had no symptoms and a stable TMC joint (Figure 1(c)). Only five paediatric TMC traumatic dislocations have been reported in the scientific literature (Table 1) (McLaughlin and Abouzahr, 1998; Nusem et al., 2001; Varitimidis and Sotereanos, 1999; Watt and Hooper, 1987). Closed reduction and percutaneous pinning might not be adequate in adults, as one-third of patients have been reported to suffer recurrent subluxation (McCarthy and Awan, 2014). It was, however, successful in our patient, as well as in a previous paediatric case (Watt and Hooper, 1987). In four of the five previously reported paediatric cases, initial treatment consisted of closed reduction and thumb spica cast application (Nusem et al., 2001; Varitimidis and Sotereanos, 1999; Watt and Hooper, 1987). This treatment failed in two patients who had delayed treatment 1 or 8 weeks after injury (Varitimidis and Sotereanos, 1999; Watt and Hooper, 1987).