Dislocations from 2nd to 4th metacarpal

Dislocations from the 2nd to the 4th metacarpal . It is the loss of traumatic anatomical relationships between the carpus and the metacarpals from the 2nd to the 4th, accompanied or not by removal of the bones corresponding to the carpus.


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  • 1 Metacarpal fractures
    • 1 Classification of dislocations
    • 2 Etiopathogenesis
    • 3 Clinical manifestations
    • 4 Complementary diagnosis
    • 5 Treatment
  • 2 Source

Metacarpal fractures

The free movement of the thumb constitutes an essential part of the mobility of the hand, this explains the relative frequency of fractures , dislocations of the metacarpal carpotrapecio joint. The remaining carpometacarpal joints have a much more limited range of motion and greater stability.

Carpometacarpal dislocations

Metacarpal fractures represent one of the most common traumatic injuries of the hand, comprising approximately 30% of the fractures that occur in this region.

They usually occur between 20 and 30 years in 70% of cases and occur mainly due to accidental falls or direct trauma. The management of these fractures is usually conservative, except in cases of displacement, angulation or compromise on the articular surface of the bone, which will require surgical intervention for reduction and fixation.

Classification of dislocations

Among dislocations they are classified into two groups:

  • Bibs, which are frequent.
  • Palmares, which are very rare.


The production mechanism is varied. It can be due to a direct blow or a traffic or work accident, when the metacarpals are fixed between two resistant objects and the hand is pushed dorsally or palmarly.

Immobilizing wrist brace with splint for methocarpal injuries

Dislocations of the four metacarpals are common, although sometimes two or three can be dislocated. Isolated dislocations are only possible in the 5th metacarpal.

Clinical manifestations

The patient arrives with pain, increased volume, bruising and helplessness of the hand. The metacarpals are prominent dorsally and are painful on palpation.

Complementary diagnosis

Radiology: X-rays are indicated in anteroposterior and lateral views in pronation. It is necessary to look for associated bone lesions such as fractures of the scaphoid, metacarpal or other carpal bones.


In recent injuries, the reduction maneuver is performed with the patient lying down and under general or local anesthesia. With the patient’s elbow at a right angle, the surgeon pulls on the fingers and the assistant pulls on the elbow, thereby reducing dislocation.

Next, a short cast is placed with the wrist in 35 ° dorsiflexion and the first phalanx is included in slight flexion, the plaster is maintained for 4 weeks after which the rehabilitation program begins.


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