The palmar carpometacarpal ligaments are robust fibrous bands on the palmar surface of the hand, connecting the distal carpal row to the bases of the second through fifth metacarpals. They are generally stronger and more numerous than their dorsal counterparts and include the Lisfranc equivalent of the hand, the ligament between the capitate and the base of the third metacarpal.
Prevent dorsal subluxation of the metacarpal bases, stabilise the CMC joints during axial loading, and maintain the transverse arch of the hand by anchoring the rigid central metacarpals to the distal carpal row.
Palmar carpometacarpal ligament disruption accompanies CMC fracture-dislocations, most commonly at the fourth and fifth CMC joints following axial loading through a clenched fist. The palmar ligaments must be repaired or supplemented by K-wire fixation to restore CMC stability. Neglected injuries lead to painful dorsal subluxation and grip weakness.
Axial force through the small finger (as in a punch) fractures the base of the fifth metacarpal and disrupts the palmar and dorsal CMC ligaments, allowing dorsal subluxation of the metacarpal base, requiring reduction and K-wire fixation.
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