isolated dislocations of the trapezio metacarpal joint without associated fracture has been reported very rarely in the literature .
there are reports of associated injuries like fracture of the trapezium , dislocation of the metacarpophalangeal joint and fractures of the base of the thumb metacarpal .
authors report a case of isolated carpometacarpal dislocation of the right thumb , in an adult , successfully managed conservatively . at 15 months follow up the patient had full function of the hand without any clinical or radiological evidence of instability or posttraumatic arthritis .
isolated dislocations can be successfully managed by closed reduction and immobilization in a back slab , with unstable dislocations requiring surgical intervention .
isolated dislocations of the trapezio metacarpal joint [ tm ] without associated fracture is a very rare injury[1 - 4 ] , with few reports in the literature .
associated injuries reported include , fractures of the trapezium [ 5 - 7 ] , dislocation of the metacarpophalangeal joint ( mp ) [ 4,8 - 10 ] , and associated fracture of the base of the metacarpal .
there is debate over optimal management of the dislocation , with reports suggesting conservative management [ 1 , 9 ] , to aggressive surgery , including ligament reconstruction [ 11 - 13 ] . however , if the joint is stable after a closed reduction , immobilization in a thumb spica can result in a stable joint .
36 year old patient presented in the accident and emergency of a regional referral hospital with pain and deformity of the right thumb , following an alleged road traffic accident .
the patient was unable to move the right thumb , and had a prominence over the dorsal aspect of the right hand .
radiographs of the right hand revealed a dorsal dislocation of the carpo - metacarpal joint of the right thumb without any associated fracture ( fig.1a , b ) .
following reduction , the tm joint was found stable , and hence it was decided to treat the dislocation in a thumb spica . he was followed up every week for the first 3 weeks with weekly radiographs which confirmed concentric reduction of the tm joint . at 6 weeks
radiograph at 15 months follow up showed well reduced and stable tm joint without any signs of arthritis
. however there was a calcified shadow over the radial aspect of the thumb ( white arrow ) , which could be due to calcification in the straight antero lateral ligament ( fig .
frontal radiograph of the hand showing the dorsal dislocation of the tm joint frontal radiograph at 15 months follow up showing calcification of the ligament [ white arrow ] , and congruent joint .
thumb has a unique role in the function of the hand , and a normal thumb is essential for digital pincing and for a powerful grip .
both trapezial and metacarpal surfaces have double inverse curvature in the shape of a saddle .
an injury which is occasionally reported is carpo - metacarpal dislocation of the thumb , can lead to long standing hand disability if not properly treated .
isolated carpometacarpal dislocation of the thumb is a very rare injury [ 1 - 4 ] , accounting for less than 1% of all hand injuries .
isolated tm dislocations almost always displace dorsally , but there are reports of volar dislocations .
most thumb dislocations are dorsal , and are classified as simple [ reduced closed ] and complex [ irreducible closed and requiring open reduction ] .
many associated injuries has been reported along with tm dislocation of the thumb , which includes fracture of the trapezium[5 - 7,15 ] , dislocation of the metacarpophalangeal joint , also known as floating thumb , injury of the ulnar collateral ligament , fracture of the distal radius and bennett fracture .
force causing flexion and axial loading of the metacarpal base result in rupture of the dorsolateral ligament and dorsal subluxation .
the dorsal ligament complex is the largest and thickest and most important ligamentous restraint [ 10 , 13 , 16 ] and if this ligament is cut , the major stabilizer is lost and a caropmetacarpal dislocation ensues [ 13 , 16 ] .
if the metacarpal is further flexed , the anterior oblique ligament is stripped from the base of the metacarpal resulting in complete dislocation [ 1 , 2 ] .
optimal treatment method is still debatable   varying from closed reduction and casting , percutaneous fixation , ligamentous repair , capsular placation followed by k wire fixation [ 1 , 2 ] .
milankov and miljjkovic has named this injury as the  bennett fracture without a fracture  implying that the injury is unstable after closed reduction as in a bennett fracture .
closed reduction and a plaster cast with the thumb in abduction , and kept for 4- 6 weeks is the preferred treatment if the joint is stable [ 1 , 4 , 8 , 9 , 13 ] .
if the joint is unstable , it is preferable to hold the reduction with k wires , with or without capsulorrhaphy .
though many ligamentous reconstructive procedures have been described using the tendons around the wrist , conservative management may still gives equally good results [ 1 , 8 ] .
however recurrent instability is a concern and ligament reconstruction should be considered in unstable cases .
our case was stable after reduction and conservative management with thumb spica gave good functional result .
marcotte and trzeciak too reported that the isolated dorsal mcp joint dislocation remains stable after closed reduction .
patients with tm dislocation showing no signs of instability after a closed reduction can be managed conservatively [ 1 , 13 ] .
post reduction the joint was stable and conservative management in spica cast gave good clinical result .
isolated tm joint dislocations , if stable after a closed reduction could be managed in a plaster cast with good functional results .
 introduction : isolated dislocations of the trapezio metacarpal joint without associated fracture has been reported very rarely in the literature . 
 there are reports of associated injuries like fracture of the trapezium , dislocation of the metacarpophalangeal joint and fractures of the base of the thumb metacarpal.case report : authors report a case of isolated carpometacarpal dislocation of the right thumb , in an adult , successfully managed conservatively . at 15 months 
 follow up the patient had full function of the hand without any clinical or radiological evidence of instability or posttraumatic arthritis.conclusion:isolated dislocations can be successfully managed by closed reduction and immobilization in a back slab , with unstable dislocations requiring surgical intervention . 
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Introduction
Case report
Discussion
CONCLUSION