Dislocation of the carpometacarpal joint of the thumb. A report of four cases.

In four cases of complete carpometacarpal dislocation of the thumb, closed reduction, although easily performed, usually had unstable results. Open reduction and internal fixation with Kirschner wires were used in two cases. The third case was stable after open reduction. The fourth patient was treated by closed reduction and percutaneous Kirschner wire fixation. The joints were immobilized in spica casts for six weeks. At follow-up examinations, two patients had asymptomatic dorsal subluxation. At two years' follow-up examinations, two of the four patients had dorsal subluxations. Open reduction and internal fixation alone were not adequate for this type of injury. The dorsal capsule and ligament should be explored during surgery and reconstructed by free tendon grafts.