Divergent dislocation of the carpometacarpal joints: a case report.

BACKGROUND: Divergent carpometacarpal joint dislocations of the fingers are very rare. Due to severe swelling and overlapping of bones on a radiograph of the wrist and hand, dislocations are missed. The purpose of this clinical case report is to highlight this unusual injury to avoid missing diagnosis. CASE PRESENTATION: We report a case of a 24-year-old Moroccan man, an athlete, who presented divergent carpometacarpal joint fracture-dislocations of the ulnar four fingers after a fall during a national cycling competition. Radiographs showed divergent dislocation and associated fractures. He underwent open reduction and fixation with percutaneous Kirschner wires followed by 6 weeks of immobilization. Active physiotherapy was started and the results were satisfactory after a 2-year follow-up. CONCLUSIONS: Divergent carpometacarpal joint dislocations of the fingers are exceptional; their diagnosis is sometimes difficult and may go unnoticed especially in a patient with polytrauma. The functional prognosis depends on the precocity of diagnosis and the quality of the reduction and rehabilitation.

Pneumothorax complicating isolated clavicle fracture.

Isolated clavicle fractures are among the commonest of traumatic fractures in the emergency department. Complications of isolated clavicle fractures are rare. Pneumothorax has been described as a complication of a fractured clavicle only rarely in English literature. In all the reported cases, the pneumothorax was treated by a thoracostomy and the clavicle fracture was treated conservatively. In our case, the pneumothorax required a chest drain insertion and the clavicle fracture was treated surgically with good result.