Open complex metacarpophalangeal joint dislocation. Two cases: index finger and long finger

New approach to second metacarpophalangeal joint dislocation management: the SKY needling technique

Second metacarpophalangeal dislocation is a rare entity, wherein correct diagnosis can be achieved by careful and experienced clinical examination that must be followed by radiological examination. This mostly requires open reduction either by dorsal or volar approach. Open reduction by volar approach is being used most widely but has more incidence of postoperative loss of sensation at volar aspect of finger due to neurovascular injury (digital nerve and vessel) and also required more extensive dissection. Dorsal approach is a rather safe alternative to volar approach as it provides better exposure to volar plate. We present a new technique wherein the chances of neurovascular injury are very rare and make it an effective and less complicated surgery.

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.

Fracture-dislocation about the finger joints

Fracture-dislocations in the small joints of the fingers are challenging injuries. The surgeon must choose an appropriate treatment based on fracture pattern, joint stability, and injury chronicity. Fracture-dislocations of the proximal interphalangeal joint are notoriously unforgiving, with potential long-term sequelae of residual pain and stiffness. Similar injuries in the distal interphalangeal joint are more tolerant of fracture displacement and even joint subluxation. Dorsal dislocations of the metacarpophalangeal joint may be associated with shearing fractures of the metacarpal head but are most notable for the volar plate interposition that may block closed reduction.

Dorsal approach for open reduction of complex metacarpophalangeal joint dislocations

The metacarpophalangeal (MP) joint is resistant to injury due to its strong capsuloligamentous structures, which include the volar plate and deep transverse metacarpal and collateral ligaments. Complex MP joint dislocations are, by definition, irreducible by closed means and require open reduction, as the volar plate becomes entrapped between the metacarpal head and proximal phalanx. The dorsal approach may offer the following advantages: 1) reduced risk to palmarly displaced neurovascular structures, 2) facilitated management of osteochondral fractures, and 3) full exposure of the volar plate. However, the dorsal approach requires splitting of the volar plate for adequate reduction, which may delay recovery.

Complex dorsal metacarpophalangeal joint dislocation caused by interosseous tendon entrapment: case report

We report a patient with open complex, dorsal metacarpophalangeal joint dislocation of the index finger with interposition of the first dorsal interosseous tendon and the transverse ligament of the palmar aponeurosis. To our knowledge, entrapment of the first dorsal interosseous tendon has not been reported to be the cause of irreducible dislocation of the metacarpophalangeal joint.

Volar open reduction of complex metacarpophalangeal dislocation of the index finger: a pictorial essay

Dislocations of the metacarpophalangeal joint are uncommon and usually caused by significant trauma. The distinction between subluxations and dislocations is critical. Complex dislocations require surgical reduction. The need for surgical reduction is primarily due to the anatomy of this region, which contributes to the complexity of this injury and to the degree of difficulty in its reduction. This pictorial essay aims to highlight the clinical, radiographic, and surgical features of this uncommon yet complex injury.

Scissoring deformity after closed reduction of a dorsal subluxation of the MP joint of the middle finger

A rare case of scissoring deformity after closed reduction of a dorsal subluxation of the MP joint of the middle finger is reported. The aetiology and treatment of this deformity are presented along with a modified classification of dorsal dislocations and subluxations of the MP joint.

An isolated complex dorsal dislocation of the MP joint of the ring finger

A rare case of isolated complex dorsal dislocation of the MP joint of the ring finger is described. Differences in the pathological findings between dislocations of the ring finger and other digits are discussed.

An isolated, closed, complex dislocation of the metacarpophalangeal joint of the long finger: a unique case

A unique case of an isolated, closed, complex metacarpophalangeal (MP) joint dislocation of the long finger is reported. The deep transverse metacarpal ligaments play an integral role in the stability of the metacarpophalangeal (MP) joints because of their firm bilateral attachments to the palmar plate. The partial rupture of this ligament during the course of trauma prevents closed reduction. Essential correction consists of incision of the remaining fibers of the ligamentous connection to the palmar plate.

Simultaneous closed dislocations of the metacarpophalangeal joints of the index, long, and ring fingers: a case report

A patient with simultaneous closed dislocation of the metacarpophalangeal joints of the index, long, and ring fingers and an ipsilateral fracture of the radius with an associated fracture-dislocation of the distal radioulnar joint is presented. This is the first such case to be described. The mechanism of injury was a fall on an outstretched hand. The dislocations of the metacarpophalangeal joints were successfully reduced by open relocation through dorsal approaches. The fractured radius was treated with open reduction and plate fixation. The patient was placed in a dorsal extension block splint after surgery, and active motion was encouraged. Eleven months later, the patient could make a full fist and extend all fingers. Grip strength was 110 pounds in the right hand, and 100 pounds in the injured left hand.

Dorsal dislocation of the fourth and fifth carpometacarpal joints and simultaneous dislocation of the metacarpophalangeal joint of the small finger: a case report

A patient with dorsal dislocation of the fourth and fifth carpometacarpal (CMC) joints and dislocation of the metacarpophalangeal (MP) joint of the small finger was managed successfully by open reduction and transarticular fixation of the CMC joint dislocation and closed reduction of the MP joint dislocation. This rare combination of injuries has not been reported previously.