Emergency Open Reduction for an Irreducible Dislocation of the Metacarpophalangeal Joint of the Thumb in a Child

Complex Dislocation of the Metacarpophalangeal Joint in the Index Finger of a Child: A Case Report

CASE

The author reports a complex metacarpophalangeal joint dislocation in a 14-year-old adolescent boy with multiple failed closed reduction manipulations and unsuccessful open procedures. The patient underwent another surgical procedure through the same volar approach, and the joint was reduced along with the volar plate repair. The functional outcome at 1-year follow-up was excellent.

CONCLUSIONS

Metacarpophalangeal dislocations of the index finger are rare in the pediatric population. The interposition of the volar plate is the significant barrier to reduction and the prime reason for unsuccessful closed reduction attempts. In such cases, surgeons may prefer a dorsal or volar approach to open and reduce the joint. Unsuccessful open reduction is rare.

Complex Metacarpophalangeal Joint Dislocation of the Index Finger in Pediatric Age: A Case Report and Review of Literature

Introduction

Metacarpophalangeal (MCP) joint dislocation is a rare occurrence in the pediatric population. A few case reports are available globally. Understanding of anatomy of the MCP joint is necessary for the surgical approach. We report a case of complex volar MCP joint dislocation in a pediatric patient.

Case Report

We report a 13-year-old male child with traumatic dislocation of the MCP joint of the index finger. It was a complex volar dislocation that was surgically treated via a dorsal approach. On 6-month follow-up, child regained an almost normal range of motion at the MCP joint with a good functional outcome.

Conclusion

Complex MCP joint dislocation often needs open reduction. Out of the two described surgical approaches, we preferred the dorsal approach which allowed proper visualization of the volar plate and avoided risks to neurovascular bundles. Early management and early mobilization provide good functional outcomes.

Dorsal Approach in the Surgical Treatment of Complex Dorsal Dislocation of Index Metacarpophalangeal Joint; a Case Report

Complex metacarpophalangeal (MCP) joint dislocation is an uncommon entity, which occurs following a hyperextension injury. Closed reduction is not feasible due to entrapped volar plate and/or coexisting fractures. Various approaches and techniques have been proposed for treatment of complex MCP dislocation; however, controversies exist over which one is superior. This study describes a right-handed 14-year-old boy who fell on the outstretched hand and sustained a dorsal dislocation of the left index MCP joint. The dislocation was complicated by an epiphyseal metacarpal head fracture with dorsal-ulnar displacement of the osteochondral fragment. The patient underwent open reduction through the dorsal approach, and the metacarpal head was fixed via the two-screw technique. The patient resumed left-hand function after six weeks. At the two-year follow-up, the range of motion and grip strength were normal, the patient was pain-free, and no sign of growth disturbance or joint stiffness was detected. Dorsal surgical approach with screw fixation is a feasible technique for the treatment of complex MCP dislocation, especially when it is complicated by a large epiphyseal head fracture.

Pediatric Complex Metacarpophalangeal Joint Dislocation of the Index Finger

Background

Metacarpophalangeal (MCP) joint dislocations are the result of a hyperextension injury. Complex MCP joint dislocations-those that are irreducible to closed maneuvers and require surgical intervention-are considered uncommon, even in the pediatric population. Although several structures have been identified that contribute to irreducible dislocations, the volar plate is the most significant barrier to reduction through interposition into the MCP joint. Key differences that require consideration for MCP joint dislocations in pediatric patients include ligamentous laxity, the absence of sesamoid bones, the possibility for cartilage fractures, and the possibility of growth arrest. Open surgical intervention for a complex MCP joint dislocation is performed through either the volar or dorsal approach. Controversy exists about which approach is superior.

Case Report

We present the case of a 7-year-old female who sustained a complex MCP joint dislocation of the index finger. After numerous unsuccessful attempts at closed reduction, the patient underwent open reduction through the dorsal approach. The phalangeal head had buttonholed through the volar plate and was reduced by using a Freer elevator as a lever and applying gentle traction and flexion. At 4-week follow-up, the patient was pain-free and had regained nearly full range of motion of the index finger MCP joint.

Conclusion

In addition to the classic volar and dorsal approaches, different techniques have been used to reduce complex dislocations in pediatric patients, including arthroscopic surgery, a percutaneous technique with manipulation of a skin hook, and a percutaneous technique with a dorsal incision. As demonstrated in this case, open reduction through the dorsal approach remains a viable treatment option for complex MCP joint dislocations in the pediatric population.

Clinical Outcome of Metacarpophalangeal Joint Dislocation of the Thumb in Children: Case Series of 10 Patients

OBJECTIVES

Dislocation of the metacarpophalangeal joint of the thumb in children is an uncommon entity. The aim of this study was to evaluate the clinical outcome of pediatric patients with metacarpophalangeal joint dislocation of the thumb.

PATIENTS AND METHODS

Ten pediatric patients with metacarpophalangeal joint dislocation of the thumb were evaluated. Patients were studied prospectively over a period of 3 years. Parameters studied included patient demographics, type of dislocation, management, and any complications.

RESULTS

Mean age of patients was 6.8 years (range: 3-12 years). Seven patients underwent closed reduction and three patients were managed by open reduction. Of the total 10 patients, excellent results were obtained in 9 patients. One of the patients who reported on the fourth day of trauma and was managed by open reduction had mild joint stiffness with a range of motion of 10 to 40 degrees at final follow-up. None of these patients had infection or instability.

CONCLUSION

After thorough clinical and radiological examination, closed reduction can be done in incomplete and simple complete dislocations of metacarpophalangeal joint of the thumb. Repeated closed reduction should be avoided in complex complete injuries. Early mobilization is advised to prevent joint stiffness.