The carpometacarpal joint is a very stable joint, and only violent trauma is likely to result in carpometacarpal dislocation of all fingers. These rare lesions pose two problems: that of emergency diagnosis and treatment. Dislocations associated with fractures are rare and displacement is generally dorsal.

A 29-year-old man, victim of a road traffic accident, was admitted to the emergency department with functional impotence of the left hand. He presented with severe, painful hematic edema of the hand. There was no sensory-motor deficit. Radiographic and CT findings showed isolated dorsal carpometacarpal dislocation of all fingers, with fracture of the base of the fifth metacarpal.

The patient was operated on under locoregional anaesthesia. We performed a double longitudinal dorsal approach. The first was centered on the second metacarpal space. The joint appeared dislocated with no apparent cartilage damage. The bases of the second and third metacarpals were reduced. The second carpometacarpal joint was pinned, providing a stable fixture. The second approach, centred on the fourth intermetacarpal space, showed that the fourth metacarpophalangeal joint had been reduced, but that the fifth remained dislocated palmarally. This joint was therefore reduced and pinned. An antebrachiopalmar cast was applied for six weeks. When the pins were removed, 20 rehabilitation sessions were performed. The patient was followed up with radioclinical assessments on day 15, day 45, month 3, month 4 and month 6. Pain, wrist mobility and strength measured with the Jamar were recorded. Resumption of work in the same position at the third month. At six months, there was no pain at rest or on exertion. Mobility was complete in the wrist, finger curl and thumb opposition, with a Kapandji score of 10. Handgrip strength was measured at 90% compared with the right side, corresponding in this right-handed patient to full recovery. There was no early radiological osteoarthritic evolution.

Carpometacarpal dislocations of all fingers account for less than 1% of all wrist and carpal. These dislocations are generally affecting young adults following high-energy trauma. That pose problems of reducibility, Surgery always consists of emergency reduction with fixation.

Fracture dislocations of the multiple carpometacarpal joints of the fingers is a rare injury. Treatment consisted of open reduction with carpometacarpal pinning adapted to intraoperative stability. This allows for the least invasive carpometacarpal pinning, adapted to the intraoperative stability reduce the risk of stiffening and residual pain. Open reduction is preferable and restores the joint the joint more anatomically.