Irreducible Dislocation of the Metacarpophalangeal Joint

Katsumi Takase

Department of Orthopedic Surgery, Tokyo Medical University, Japan

^*Correspondance to: Katsumi Takase 

 PDF  Full Text DOI: 10.25107/2474-1647.1997

Abstract

Dorsal dislocation of the Metacarpophalangeal (MP) joint is less common in the thumb. Simple MP joint dislocations are described that a closed reduction is expected to be relatively easy. However, 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. We present a case of dorsal complex MP joint dislocation of the thumb. A 20-year-old right-hand dominant young lady presented to our hospital with complaints of pain and deformity of the right thumb. The plain radiographs demonstrated dorsal complete dislocation of MP joint, and that a sesamoid bone was trapped within the joint space. We performed a surgical procedure using dorsal approach on this patient. A curvilinear incision was made overlying the MP joint. We confirmed the proximal end of the phalanx lying completely dorsal to the metacarpal head. The inspection of the joint revealed that the volar plate and sesamoid bones were completely dorsally translocated over the metacarpal head. A freer elevator was passed over the metacarpal head to distract open the MP joint space, and gentle, distally directed pressure was applied to the end of the proximal phalanx to reduce the MP joint. We attempted several time this maneuver to maintain the continuity of the volar plate. Finally, we confirmed a stable reduction through full range of motion.

Keywords

Irreducible dislocation; Metacarpophalangeal joint; Thumb; Volar plate

Cite the article

Takase K. Irreducible Dislocation of the Metacarpophalangeal Joint. Clin Surg. 2018; 3: 1997.