A Rare Volar Carpo-metacarpal Joint Dislocation in a Child: A Case Report and Literature Review.

INTRODUCTION: Carpometacarpal joint (CMCJ) dislocations are a rare presentation and a volar dislocation in a pediatric patient even more so. We present a case of this condition along with management strategies to help guide future treatment of this injury.

CASE REPORT: A fit and well 8-year-old boy presented with pain and deformity of his right hand following a fall from a horse. He had no history of previous trauma or injury to this hand. X-rays demonstrated a volar dislocation of the second CMCJ, along with several metacarpal base fractures. This injury was managed emergently with closed reduction in the Emergency Department and then underwent definitive treatment through percutaneous Kirschner wire (K-wire) fixation 2 days after injury. At 3- month follow-up, the patient and his family reported no pain, and on examination, there was no deformity and he had excellent range of motion. The patient had already returned to horse riding with no issues.

CONCLUSION: A volar carpometacarpal dislocation in a pediatric patient is an uncommon presentation. We were able to achieve a full functional recovery using a mixture of closed reduction and K-wire fixation techniques. This clinical experience offers several learning points and also guidance around management strategies for future presentations of this condition.