Metacarpophalangeal joint dislocation

Complex dorsal metacarpophalangeal joint dislocation associated with proximal metacarpal fracture: case report and review of the literature

INTRODUCTION

Complex dorsal metacarpophalangeal joint (MCPJ) dislocations are uncommon injuries that mainly affect the index finger and are typically caused by a fall on an outstretched hand. It is exceptional for complex MCPJ dislocation to coexist with a distal fracture of the corresponding metacarpal bone.

PRESENTATION OF THE CASE

The authors report a case of a 23-year-old man presented to the emergency, with a complex dorsal metacarpophalangeal joint dislocation of the index associated with a distal metacarpal fracture confirmed by imaging. The patient had an open reduction and internal fixation of the proximal metacarpal fracture. The results were satisfying.

DISCUSSION

Dorsal MCP joint dislocations are rare, primarily affecting the index and little fingers, and are typically caused by a fall on an outstretched hand. Complex dislocations, characterized by irreducibility, involve structures forming a "noose" around the metacarpal head. Fractures associated with these dislocations are uncommon. Early diagnosis is crucial for better long-term functional outcomes. Radiographic imaging, including three different views, is necessary for accurate diagnosis. Surgery is usually required, with different approaches depending on the case. Arthroscopic techniques can be used when reduction is challenging. Timely surgical intervention yields the best results. Stiffness, osteoarthritis, osteonecrosis, and growth arrest in pediatric cases are the main complications.

CONCLUSION

Complex dorsal metacarpophalangeal joint (MCPJ) dislocations are rare. Open reduction is typically necessary for optimal outcomes. Complications such as stiffness, osteoarthritis can arise, emphasizing the importance of accurate diagnosis and appropriate management.

Complex Open Metacarpophalangeal Joint Dislocation of the Index Finger in a Pediatric Patient: A Case Report

Pediatric metacarpophalangeal (MCP) joint dislocations are rare. Open MCP injuries are rarer. There are different surgical approaches to its treatment, and each approach has advantages and disadvantages. Debridement and open reduction should be performed urgently in the treatment. In our study, we will present the treatment and follow-up of a 15-year-old patient with an open index finger MCP joint dislocation. In conclusion, open MCP dislocations adversely affect hand function when their treatment is delayed, and complications can be avoided if full anatomical reduction and soft tissue reconstruction are performed quickly.

Does Irreducibility Always Mean a Complex Dislocation? An Analysis of 33 Pediatric Metacarpophalangeal Joint Dislocations

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.

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.

Acute Bony Injuries of Hand and Wrist

Acute bony injuries to the hand and wrist are very common after a fall on an outstretched hand. In the wrist, distal radius fractures are the most common; isolated distal ulna fractures are uncommon. More serious injuries to the wrist include complicated fracture-dislocation injuries such as perilunate dislocations. At the carpal level, scaphoid fractures are the most common followed by fractures of the dorsal side of the triquetrum. The metacarpals often fracture, most commonly the base of the thumb and the subcapital region of the fifth metacarpal. In the fingers, we encounter many different types of fractures, often avulsions reflecting underlying soft tissue pathology (e.g., mallet finger). Dislocations are common in the fingers, predominantly in the distal interphalangeal joints. From an imaging standpoint, conventional radiography is always the initial examination. Complex (intra-articular) fractures, fracture-dislocation injuries, and a strong clinical suspicion of radiographically occult fractures need to be further evaluated for decision making regarding treatment. Computed tomography is the primary imaging modality of choice for the first two. In the latter, magnetic resonance imaging can be preferable, depending on clinical suspicion and the local situation in the associated hospital.

Dislocation of the metacarpophalangeal joint of the index finger requiring open reduction due to the presence of an intra-articular sesamoid bone

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.

Complex metacarpophalangeal joint dislocation of the litter finger: A sesamoid bone seen within joint. What does it mean?

Dislocation of the metacarpophalangeal joint is a rare injury. The index finger is most frequently involved, followed by the thumb; the little finger is very seldom affected. The Complex dislocation of the little finger metacarpophalangeal joint is extremely rare. A few cases only had been described. Herein, we report a case of 40 years old presented, after a road accident, a dorsal metacarpophalangeal joint dislocation of the litter finger confirmed on radiographs with a clear view of the sesamoid bone within joint prompting the patient to undergo open reduction with no attempts of closed reduction initially. We elected, to treat our case, for the volar approach which allowed successful relocation of the head of the metacarpal in its anatomical position. The view of sesamoid bone within the joint is pathognomonic of volar plate entrapment. Recognition of this fact should alert the treating physician to the inevitability of open reduction for anatomical repositioning of the joint and avoid repeated attempts at closed reduction which may arise the risk of degenerative arthritis and reduced final range of motion.

The Lateral Approach in the Surgical Treatment of a Complex Dorsal Metacarpophalangeal Joint Dislocation of the Index Finger

Complex dorsal metacarpophalangeal (MCP) joint dislocations as a result of hyperextension injuries are uncommon in the pediatric population and irreducible to closed maneuvers. Treatment of these complex lesions is invariably surgical, and dorsal or volar approaches are traditionally used. The authors describe a case of a 16-year-old male who suffered a fall onto his outstretched right hand in a soccer game. The patient presented to the ER with pain and deformity of the index finger MCP joint. Radiographs confirmed a complex MCP dislocation with a small osteochondral fragment. A lateral surgical approach was made, and interposition of the volar plate and an osteochondral fragment blocking the reduction were found. This versatile approach allowed access to volar and dorsal structures, minimizing the risk of surgical scarring and mobility arch limitation. To our knowledge, there are no reported cases regarding a lateral surgical approach.

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.

Indication for CT following index finger metacarpophalangeal joint dislocation – A case report

Currently Kaplan's criteria on examination are used as the gold standard diagnostic tool for complex dorsal dislocations of the index finger Metacarpophalangeal joint. Our case report reveals a situation when the diagnosis was obscure and when conventional X-rays were not beneficial.

With the use of CT imaging we were able to confirm the diagnosis of complex dorsal dislocation of the index finger Metacarpophalangeal joint and also reveal multiple other injuries. We feel that CT imaging should be performed on every individual who has been diagnosed with this injury or where the diagnosis cannot be confirmed with conventional methods.

CT can be useful in diagnosis of index finger Metacarpophalangeal joint dislocations and also in diagnosing other fractures that may have been sustained in this high energy/impact injury.

Identifying and treating traumatic hand and wrist injuries

Proper identification and management of traumatic hand and wrist injuries is critical to preventing loss of function, nerve damage, joint instability, persistent pain, and delay in indicated surgery. This article uses case studies to help clinicians make accurate diagnoses and treatment plans. Physical examination findings, radiograph results, and treatment plans are reviewed for four traumatic hand and wrist fractures or dislocations.

Volar Dislocation of the Metacarpophalangeal Joint of the Ring Finger Complicated with Chondrolysis: A Case Report and Review of the Literature

Volar dislocation of the metacarpophalangeal joint is rare injury. In the literature consulted only seven cases of isolated volar dislocation of the metacarpophalangeal joint of the ring finger have been published. Chondrolysis associated with the metacarpophalangeal joint dislocation has not been reported in the English literature. In this paper, an unusual case of volar dislocation of the metacarpophalangeal joint is presented and a review of the literature is described.

Dorsal Approach Decreases Operative Time for Complex Metacarpophalangeal Dislocations

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.

Complex Dorsal Metacarpophalangeal Dislocation: Long-Term Follow-Up

PURPOSE

To describe the long-term follow-up results of complex dorsal metacarpophalangeal joint dislocation (MPJD). We hypothesize that there would be no long-term functional deficit in most patients, even with the presence of one of the familiar complications.

METHODS

We describe 5 patients with a median follow-up of 13 (range, 7-36) years and review the literature focusing on follow-up and complications.

RESULTS

All patients reported full function of the hand. Compared with the contralateral finger, a mild loss of MPJ flexion was noted in 2 patients. Grip strength was reduced in 2 patients. The mean QuickDASH score was 4.5 (range, 0-20.5). Two patients with osteochondral metacarpal head fractures treated with screw fixation demonstrated secondary osteoarthritis changes on x-ray. The literature indicates that complications in patients with complex dorsal MPJD are related to failure of diagnosis, multiple attempts at closed reduction, concomitant osteochondral fracture, traumatic open reduction, or prolonged immobilization, and may result in joint stiffness, early degenerative arthritis, or osteonecrosis of the metacarpal head, pain, premature epiphysis closure, and metacarpal shortening.

CONCLUSIONS

The findings from this study suggest that complex dorsal MPJD treated on the day of injury with dorsal or volar open reduction techniques can eventually result in a satisfactory outcome, even with one of the complications mentioned.

TYPE OF STUDY/LEVEL OF EVIDENCE

Prognostic V.

Surgical exposures of the hand

Surgical approaches to the hand are commonly executed in the treatment of fractures, ligament injuries, and less commonly in the resection of bony tumors. Careful design and execution of these surgical approaches translates into superior functional and aesthetic outcomes. We have provided a thorough review of commonly used approaches to the hand by evaluating each of these approaches in the context of core principles including safety, versatility, preservation of stability, and aesthetic outcomes.