Volarly extruded fractures of the index metacarpal base ulnar condyle: report of two cases.

We report the cases of two men aged 35 and 33, who presented with similar injuries following a fall. They presented with pain isolated to the area of the index finger metacarpal base. Radiographs demonstrated an index metacarpal base fracture with a similar large ulnar-sided articular fragment extruded vol-arly. In the first patient the fragment was immediately adjacent to the remaining metacarpal base, with a minimally displaced extension of the fracture line to the radial cortex. In the second patient the fracture fragment had extruded into the subcutane-ous tissues of the palm; he had also suffered radial Short report letter subluxation of all four finger metacarpals at the car-pometacarpal joints (Figures 1(a)–(b)). In the first patient we performed an open reduction via a dorsal approach. The extruded ulnar fragment was completely devoid of soft tissue. We reduced the fragment and held it in place with a K-wire with additional K-wires from the index to the middle finger metacarpal for stability. We also harvested bone graft from the distal radius and put it into the metaphyseal defect. The second patient presented 3 weeks after their injury. We performed open reduction of all four car-pometacarpal joints via a dorsal approach using two longitudinal incisions. The joints were reduced and held with a K-wire across each carpometacarpal joint. The extruded ulnar fragment was retrieved via a volar incision (Figure 2). Again, this fragment had no attached soft tissue. It was also reduced and held with a K-wire (Figure 3). Figure 1. Preoperative (a) anteroposterior (AP) and (b) lateral radiographs of the fracture as well as carpometacarpal sub-luxations. Arrow indicates the volarly displaced fracture fragment.