Chronic volar dislocation of the metacarpophalangeal joint of the thumb: a case report and review of the literature

[Dorsal plate arthrodesis of the thumb metacarpophalangeal joint]

OBJECTIVE

Elimination of pain or instability by arthrodesis of the thumb joint in functional position by dorsal plateosteosynthesis.

INDICATIONS

Painful primary or secondary arthrosis of the thumb, nonreconstructable ulnar, radial or palmar instability, posttraumatic dislocation, defect injuries, bone tumors in the region of the thumb metacarpophalangeal joint.

CONTRAINDICATIONS

Local infection of the thumb metacarpophalangeal joint area.

SURGICAL TECHNIQUE

Dorsal approach to the thumb metacarpophalangeal (MP) joint, splitting of the extensor aponeurosis between the extensor pollicis longus and extensor pollicis brevis tendon. Opening of the anterior capsule and separation of the collateral ligaments, open up the joint, narrow concave and convex joint surface resections, adjustment of the arthrodesis position in 10-20° flexion and K‑wire transfixation, dorsal plateosteosynthesis, fine adjustment of the flexion, axis and pronation position. Closure of the capsule and the periosteal gliding tissue over the plate, reconstruction of the extensor aponeurosis.

POSTOPERATIVE MANAGEMENT

Splint for 3 weeks. Full load after 6-8 weeks.

RESULTS

The dorsal plate arthrodesis of the thumb MP joint is a reliable surgical method with very good functional results.

Volar dislocation of the metacarpophalangeal joint of the thumb: A case report

We present an 18 year-old patient with a volar dislocation of the metacarpophalangeal joint of the thumb. Open reduction was performed through a dorsal incision. Because of the soft tissue interposition such as dorsal capsule, volar plate, dislocated extensor pollicis longus and brevis tendons, ruptured ulnar collateral ligament; open reduction, soft tissue and ligament repair are recommended for this type of thumb dislocations.

An Unusual Case of Volar Dislocation of Thumb Metacarpophalangeal Joint

Thumb metacarpophalangeal joint dislocation is an uncommon injury. Most of the dislocations are dorsal, and volar dislocation is rare. Only a total of 18 cases of volar dislocation of thumb metacarpophalangeal joint are published in English and other international languages. Successful closed reduction was uncommon. The majority of these volar dislocations required open reduction. In this paper, an unusual case of volar dislocation of the thumb metacarpophalangeal joint that finally required arthrodesis was reported.

Palmar dislocation of the thumb metacarpophalangeal joint: report of four cases and a review of the literature

We report four cases of palmar dislocation of the thumb metacarpophalangeal joint and review of an additional 22 cases in the literature. Our four cases were associated with ligamentous injuries that prevented stable closed reduction. The patients were treated with open reduction and ligament repair and ultimately had a decreased range of motion. Our four cases and the 22 cases from literature fall into three types: Type A - stable joint (the metacarpophalangeal joint is stable, without severe ligament injury); Type B - tendon block (palmar displaced extensor tendons within the metacarpophalangeal joint prevents reduction); and Type C - joint instability (the metacarpophalangeal joint is unstable because of severe collateral ligament disruption). Type B is the most commonly reported type of palmar dislocation of the thumb metacarpophalangeal joint, with distinct features of the involvement of the collateral ligaments and failure of attempted manual reduction. The patients without severe collateral ligament disruption were managed with conservative treatment. The patients with interposition of extensor tendons and the patients with instability resulting from severe ligamentous injuries require surgical treatment.

Arthrodesis of the metacarpophalangeal joint of the thumb using a Herbert screw

We describe a technique for thumb metacarpophalangeal joint arthrodesis by using a Herbert screw. This method of fixation helps in avoiding some of the potential problems associated with wire fixation, tension-band arthrodesis, or plate fixation. Therefore, it eliminates the risk of pin track infection, pin breakage, and painful protrusion under the skin requiring metalwork removal.