Metacarpophalangeal joint arthroscopy in the fingers other than the thumb: Retrospective comparison of horizontal versus vertical traction

Metacarpophalangeal Joint Arthroscopy: Indications and Techniques through a Clinical Series

Background  Metacarpophalangeal (MCP) joint arthroscopy has been available for many years but sparingly used in typical orthopaedic and hand surgery daily practice. Difficult problems are solved with this technique in a practical and minimally invasive manner. This study describes our diverse experience and broad clinical applications of MCP arthroscopy as well as clinical results. It aims to highlight this technique as one of the tools for a fully trained hand surgeon, avoiding open management and its high complications rates. Methods  We present a retrospective clinical series of 79 patients treated with MCP arthroscopy with a mean age of 44 years old. Demographics, surgery, and clinical outcomes were collected in standardized clinical assessments. Results  We divided the sample into 20 articular metacarpal or proximal phalanx acute fracture with full functional fist and range of motion at 60 days after surgery. Regarding collateral tears, 12 were classified as acute and 47 as chronic. Two patients were reoperated for further gain range of motion. Conclusions  We present an up-to-date publication of our experience in MCP arthroscopy and its applications, with a low complication rate and excellent clinical results. We encourage hand surgeons to incorporate this technique in MCP joint challenging issues. Level of Evidence  IV.

Metacarpophalangeal portal safety. An anatomical study

AIM

To quantify the risk of dorsal innervation injury when performing direct metacarpophalangeal joint portals of the second to fifth fingers.

MATERIAL AND METHOD

An anatomical study of 11 upper limbs of fresh corpses was carried out. After placing them in a traction tower, the metacarpophalangeal portals were developed on both sides of the extensor tendon. The dorsal sensory branches were dissected and the distances between the portal and the nearest nerve were measured by a digital caliper. The portals of all the fingers were compared globally to assess the safest finger and two to two radial and ulnar portals were compared in each of the fingers to assess the safest portal within each finger.

RESULTS

The overall comparison of all portals and fingers showed that the third finger is the safest in any of its portals, while the ulnar side of the second and radial of the fourth are the portals with the highest risk of nerve injury (P=8.96·10^-5). Comparing two to two of the radial and ulnar portals in each of the fingers showed that the ulnar portal is safer than the radial on the fourth finger (P=.042), while the radial is safer than the ulnar on the fifth finger (P=.003).

CONCLUSIONS

The third finger was the safest to perform metacarpophalangeal portals, while the ulnar side of the second finger and radial side of the fourth had the highest risk of nerve injury.

Progress and Role of Finger Joint Arthroscopy

This article describes the authors' experience with, and recent advancement in, the techniques that have allowed the development of many new arthroscopic procedures in the finger joints. It also describes the role and techniques of arthroscopy in small finger joints. Because the intra-articular anatomy of the first to the fifth metacarpophalangeal (MCP) joints is similar, this article discusses the hand MCP joints without distinguishing thumb from fingers.