Complete Occlusion of Radial and Ulnar Arteries Following Hand Crush Injury with Multiple Carpometacarpal Joint Fracture-Dislocations

Abstract

Multiple dorsal fracture-dislocations of the carpometacarpal joints (CMCJ) occur from very high-energy trauma and are often associated with soft tissue injury or ischaemia. We report a 54-year-old male manual worker smoker who presented to emergency room history compression his right hand in press machine. Radiographs showed scapho-trapezio-trapezoidal third fifth CMCJ's. Despite emergent Guyon canal carpal tunnel release closed reduction pinning, skin pallor persisted all digits. Brachial angiography revealed total occlusion radial ulnar arteries loss palmar arch at level fracture. Heparin Alprostadil were injected directly. On follow-up three weeks later, vessels still occluded collaterals provided digital circulation. Although sensations recovered, cold intolerance stiffness resulted poor functional outcome. Level Evidence: V (Therapeutic).