1
|
Bauder AR, Graham EM, Shubinets V, Mendenhall SD, Carrigan RB, Lin IC, Shah A, Chang B. Does Irreducibility Always Mean a Complex Dislocation? An Analysis of 33 Pediatric Metacarpophalangeal Joint Dislocations. Plast Reconstr Surg 2023; 152:662e-669e. [PMID: 36946903 DOI: 10.1097/prs.0000000000010455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/23/2023]
Abstract
BACKGROUND Previous failed reduction and certain radiographic indicators historically have been used to differentiate simple and complex metacarpophalangeal joint (MPJ) dislocations in children, the latter of which warrants open reduction. This investigation aimed to determine the necessity for open reduction with these indicators and establish a new treatment algorithm and educational focus for these rare injuries. METHODS A 12-year retrospective study was conducted on all children with MPJ dislocations at a single pediatric hospital. The rates of successful closed reduction, number of reduction attempts, and radiographic findings were detailed. Operative details and postoperative outcomes were also gathered. RESULTS Thirty-three patients with a mean age of 11.1 years were included. Most were male [ n = 27 (82%)] and had undergone two or more previous reduction attempts at an outside facility. Stable closed reduction was then achieved outside of the operating room in five patients and in the operating room under general anesthesia in another 14, for a total of 19 of 33 patients (57.6%). The thumb was injured most often [ n = 19 (57.6%)] and more likely to undergo successful closed reduction ( P = 0.04). There was no relationship between number of previous reduction attempts and ability to achieve closed reduction ( P = 0.72). Neither joint-space widening nor proximal phalanx bayonetting was correlated radiographically with failure of closed reduction ( P = 0.22 and P = 1, respectively). CONCLUSIONS This study supports closed reduction of pediatric MPJ dislocations in the operating room under general anesthesia before conversion to open reduction, regardless of injury characteristics or previous reduction attempts. This strategy is likely to limit unnecessary open surgery and related risks. CLINICAL QUESTION/LEVEL OF EVIDENCE Risk, IV.
Collapse
Affiliation(s)
| | - Emily M Graham
- From the Divisions of Plastic and Reconstructive Surgery
| | - Valeriy Shubinets
- Orthopaedic Surgery, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania
| | - Shaun D Mendenhall
- From the Divisions of Plastic and Reconstructive Surgery
- Curtis National Hand Center, MedStar Union Memorial Hospital
| | | | - Ines C Lin
- From the Divisions of Plastic and Reconstructive Surgery
| | - Apurva Shah
- Curtis National Hand Center, MedStar Union Memorial Hospital
| | - Benjamin Chang
- From the Divisions of Plastic and Reconstructive Surgery
- Curtis National Hand Center, MedStar Union Memorial Hospital
| |
Collapse
|
2
|
Praz E, Vostrel P, Coen M. [Open metacarpophalangeal dislocation]. PRAXIS 2023; 112:42-44. [PMID: 36597689 DOI: 10.1024/1661-8157/a003959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
Open metacarpophalangeal dislocation Abstract. Dislocation of a finger is a pathology often encountered in emergency centers. The following case example provides a reminder of its management and the situations in which the patient should be referred to the specialist.
Collapse
Affiliation(s)
- Elodie Praz
- Service de Médecine de Premier Recours, Hôpitaux Universitaires de Genève, Genève, Suisse
| | | | - Matteo Coen
- Service de Médecine Interne Générale, Département de Médecine, Hôpitaux Universitaires de Genève, Genève, Suisse
- Unité de Développement et de Recherche en Education Médical (UDREM), Université de Genève, Genève, Suisse
| |
Collapse
|
3
|
Natroshvili T, Molenaar R. A rare dislocation: an open isolated palmar dislocation of the head of the fifth metacarpal bone without fracture. CASE REPORTS IN PLASTIC SURGERY AND HAND SURGERY 2021; 8:110-113. [PMID: 34368400 PMCID: PMC8317917 DOI: 10.1080/23320885.2021.1956934] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
We present an open and isolated palmar dislocation of the head of the fifth metacarpal bone without fracture. The diagnosis, which was initially made based on the X-rays, was confirmed during the operation. The patient was satisfactorily treated with open reduction, Kirschner wires fixation and casting followed with hand physiotherapy.
Collapse
Affiliation(s)
- Tinatin Natroshvili
- Department of Plastic Surgery, Treant Health Care Group: Hospital Location Bethesda, Hoogeveen, The Netherlands
| | - Rombout Molenaar
- Department of Plastic Surgery, Treant Health Care Group: Hospital Location Bethesda, Hoogeveen, The Netherlands
| |
Collapse
|
4
|
O'Neill ES, Qin MM, Chen KJ, Hansdorfer MA, Doscher ME. Dislocation of the metacarpophalangeal joint of the index finger requiring open reduction due to the presence of an intra-articular sesamoid bone. SAGE Open Med Case Rep 2021; 9:2050313X211021180. [PMID: 34158946 PMCID: PMC8182208 DOI: 10.1177/2050313x211021180] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Accepted: 05/09/2021] [Indexed: 11/16/2022] Open
Abstract
Complex dislocation of the metacarpophalangeal joint of the index finger is rare and
often requires surgical intervention. Here, we present a case of an index finger
metacarpophalangeal joint dislocation requiring open reduction due to obstruction by a
displaced volar plate and the intra-articular entrapment of a sesamoid bone. Surgical
approach was performed dorsally, allowing easy visualization of the volar plate and
sesamoid bone as well as minimizing risk to the radial digital nerve to the index finger.
Postoperatively, the patient reported good functional return despite the delay in
definitive management.
Collapse
Affiliation(s)
- Elizabeth S O'Neill
- Division of Plastic & Reconstructive Surgery, John H. Stroger, Jr. Hospital of Cook County, Chicago, IL, USA.,Division of Plastic & Reconstructive Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Mia M Qin
- Department of Orthopaedic Surgery, Northwestern University, Chicago, IL, USA
| | - Kevin J Chen
- Chicago Medical School, Rosalind Franklin University of Medicine and Science, North Chicago, IL, USA
| | - Marek A Hansdorfer
- Division of Plastic & Reconstructive Surgery, John H. Stroger, Jr. Hospital of Cook County, Chicago, IL, USA.,Division of Plastic & Reconstructive Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Matthew E Doscher
- Division of Plastic & Reconstructive Surgery, John H. Stroger, Jr. Hospital of Cook County, Chicago, IL, USA
| |
Collapse
|
5
|
Teo I, Duck E, McNab I. Complex thumb metacarpophalangeal joint dislocation caused by ulnar collateral ligament entrapment in a 6-year-old. J Hand Surg Eur Vol 2019; 44:1092-1094. [PMID: 31403873 DOI: 10.1177/1753193419867007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- Isabel Teo
- Nuffield Orthopedic Centre, Oxford University Hospitals, Oxford, UK
| | - Eleanor Duck
- Nuffield Orthopedic Centre, Oxford University Hospitals, Oxford, UK
| | - Ian McNab
- Nuffield Orthopedic Centre, Oxford University Hospitals, Oxford, UK
| |
Collapse
|
6
|
Tohyama M, Iida K, Konishi S. Iatrogenic displacement of the metacarpal head of the index finger while attempting closed reduction of a complex dorsal metacarpophalangeal joint dislocation. Trauma Case Rep 2019; 23:100243. [PMID: 31517016 PMCID: PMC6727105 DOI: 10.1016/j.tcr.2019.100243] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/19/2019] [Indexed: 11/28/2022] Open
Abstract
We describe the case of an 84-year-old woman with a dorsal dislocation of the metacarpophalangeal (MCP) joint of the left index finger. Closed reduction was performed at an orthopaedic clinic which led to an iatrogenic complete displacement of the second metacarpal head to the volar side. Because reduction was impossible, surgery was performed. The metacarpal head was reduced and fixed with two headless intramedullary screws. Careless attempting a closed reduction of the complex dorsal MCP joint dislocation might be contraindicated in elderly patients with bone fragility.
Collapse
Affiliation(s)
- Masahiko Tohyama
- Department of Orthopaedic Surgery, Osaka Rosai Hospital, Osaka, Japan.,Department of Orthopaedic Surgery, Osaka General Hospital of West Japan Railway Company, Osaka, Japan
| | - Ken Iida
- Department of Orthopaedic Surgery, Osaka General Hospital of West Japan Railway Company, Osaka, Japan
| | - Sadahiko Konishi
- Department of Orthopaedic Surgery, Osaka General Hospital of West Japan Railway Company, Osaka, Japan
| |
Collapse
|
7
|
Barrera-Ochoa S, Nuñez J, Mir X. Isolated open metacarpophalangeal dislocation of the little finger. HAND SURGERY & REHABILITATION 2018; 37:324-325. [DOI: 10.1016/j.hansur.2018.06.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/03/2017] [Revised: 05/30/2018] [Accepted: 06/23/2018] [Indexed: 10/28/2022]
|
8
|
Atiyya AN, Soliman RA. Simultaneous open and Closed Dislocation of four Metacarpophalangeal Joints: A Case Report and Review of Literature. J Orthop Case Rep 2017; 6:67-69. [PMID: 28116274 PMCID: PMC5245943 DOI: 10.13107/jocr.2250-0685.512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Introduction: Multiple simultaneous dislocations of the metacarpophalangeal joints are exceedingly rare. Five cases only were described in the English literature. Only one case necessitated open reduction. A case of simultaneous open and closed dislocation of ipsilateral four metacarpophalangeal joints is presented. The case had a delayed presentation (8 days following the trauma) and needed open reduction. Case presentation: A 33-year-old manual worker sustained dislocation of the ulnar four metacarpophalangeal joints of his non dominant hand. The hand injury was missed for eight days. The injury was successfully managed by open reduction. The patient regained near normal functional outcome. Conclusion: Open reduction may be needed for these injuries. Prompt intervention and early rehabilitation are needed for satisfactory outcome.
Collapse
Affiliation(s)
- Ahmed Naeem Atiyya
- Department of Orthopedic, Ain Shams University, Abbasia Square Cairo-Egypt
| | - Ramy Ahmed Soliman
- Department of Orthopedic, Ain Shams University, Abbasia Square Cairo-Egypt
| |
Collapse
|
9
|
Vadala CJ, Ward CM. Dorsal Approach Decreases Operative Time for Complex Metacarpophalangeal Dislocations. J Hand Surg Am 2016; 41:e259-62. [PMID: 27406323 DOI: 10.1016/j.jhsa.2016.05.020] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2016] [Revised: 05/15/2016] [Accepted: 05/30/2016] [Indexed: 02/02/2023]
Abstract
PURPOSE Complex metacarpophalangeal (MCP) dislocations require open surgical reduction, but surgeons disagree about the best surgical approach. We hypothesized that a dorsal approach would require less operative time than would a volar approach and result in a decreased need for a secondary approach. METHODS We performed a retrospective chart review of all isolated irreducible dorsal MCP dislocations treated at 2 level 1 trauma centers between 2005 and 2015. We recorded the initial surgical approach (volar or dorsal), total operative time, and whether the surgeon used a second surgical approach. Operative times for initial volar approach versus initial dorsal approach, hand surgeon versus non-hand surgeon, and thumb versus other digits were compared using the 2-tailed Student t test. We used Fisher exact test to compare the need for a second approach between the volar and dorsal approach groups. RESULTS A total of 21 patients (22 digits) with MCP dislocations required surgical reduction. Average operative time was longer for the 14 patients who underwent the initial volar approach (70 minutes) than for the 7 who underwent an initial dorsal approach (45 minutes). Six of the 14 MCP joints approached volarly (42%) required a second dorsal approach. None of the 7 patients in the dorsal group required a second approach. CONCLUSIONS Using a dorsal approach to reduce complex MCP dislocations reduces operative time and decreases the need for a secondary approach. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic IV.
Collapse
Affiliation(s)
- Cathryn J Vadala
- Department of Preventative Orthopaedics, HSHS St. Mary's Hospital Medical Center, Green Bay, WI
| | - Christina M Ward
- Department of Orthopaedic Surgery, Regions Hospital, University of Minnesota, Saint Paul, MN.
| |
Collapse
|
10
|
Kodama A, Itotani Y, Mizuseki T. Arthroscopic reduction of complex dorsal metacarpophalangeal dislocation of index finger. Arthrosc Tech 2014; 3:e261-4. [PMID: 24904773 PMCID: PMC4044501 DOI: 10.1016/j.eats.2013.11.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2013] [Accepted: 11/22/2013] [Indexed: 02/03/2023] Open
Abstract
Complex dorsal dislocation of the metacarpophalangeal joint is an uncommon injury, typically caused by entrapment of the volar plate within the joint space. Closed reduction of the dislocation is not effective; instead, open reduction is necessary to release the soft tissues interposed between the metacarpal head and the proximal phalanx. However, an operative risk of digital nerve injury exists because of intricate displacement of the normal anatomy. We successfully reduced a dislocation by arthroscopic release of the entrapped volar plate. The case involved an 11-year-old boy with a complex dorsal dislocation of the metacarpophalangeal joint of the right index finger that had failed closed reduction. This technique allowed for reliable joint reduction, enabling observation of the structures obstructing the reduction; was less invasive; and avoided the risk of neurovascular injury. It is a reasonable method to use when the volar plate prevents reduction of the dislocation.
Collapse
Affiliation(s)
- Akira Kodama
- Address correspondence to Akira Kodama, M.D., Ph.D., Department of Orthopaedic Surgery, Hiroshima Prefectural Rehabilitation Center, Taguchi 295-3, Saijo, Higashi-Hiroshima, Hiroshima 739-0036, Japan.
| | | | | |
Collapse
|
11
|
Shah CM, Sommerkamp TG. Fracture dislocation of the finger joints. J Hand Surg Am 2014; 39:792-802. [PMID: 24679912 DOI: 10.1016/j.jhsa.2013.10.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2013] [Revised: 10/02/2013] [Accepted: 10/06/2013] [Indexed: 02/02/2023]
Abstract
Fracture dislocations of the hand are difficult and often unforgiving injuries. Keys to treatment include early recognition, stable concentric reduction, and protected early active range of motion maintaining joint stability. The balance between stability and mobility is difficult to manage; therefore, surgeons need a wide array of treatments to tailor management to the specific fracture pattern. With appropriate treatment, residual stiffness and pain can be minimized. This Current Concepts review aims to provide up-to-date management for proximal interphalangeal, distal interphalangeal, and metacarpophalangeal joint fracture dislocations.
Collapse
Affiliation(s)
- Chirag M Shah
- University of Cincinnati, Department of Orthopedics-Hand Surgery Specialists, Cincinnati, OH
| | - T G Sommerkamp
- University of Cincinnati, Department of Orthopedics-Hand Surgery Specialists, Cincinnati, OH.
| |
Collapse
|
12
|
|