Complex, Multidirectional Carpometacarpal Dislocations: A Case Report.

Case: We present a rare combined convergent-divergent carpometacarpal (CMC) fracture dislocation with median nerve involvement in a young adult after a motorbike accident. Radiographs revealed a volar dislocation of the second and fifth metacarpals and dorsal dislocation of the third and fourth metacarpals with bases of the second and fifth metacarpals found to be converging in the coronal plane. Open reduction and fixation was performed with carpal tunnel release.
Conclusion: Combined convergent-divergent CMC fracture dislocation should be kept as a differential while evaluating CMC dislocations. Metacarpal cascade line (posteroanterior view) and 2 lateral views (radial side up and ulnar side up) with computed tomography scan (3-dimensional reconstruction) prove to be vital in such high-energy trauma.