History: 20 year-old male punched a wall with his right fist and had immediate pain and swelling over the the dorsal and ulnar aspect of the hand and wrist. X-rays demonstrated a fracture of the hamate bone with the 4th and 5th metacarpal bones dislocated dorsally. Live flouroscopic imaging in the office demonstrated that they could be reduced manually but were unstable.
Diagnosis: Right 4th and 5th carpal-metacarpal joint fracture dislocation
Treatment: Right 4th and 5th CMC Closed Reduction and Pinning
Outcome: He remained in a cast after surgery for 4 weeks. After 1 month he was transitioned to a removable splint and started on exercises for motion.
By 2 months after surgery he had near-anatomic alignment of the joint, full motion, and no pain.