Irreducible volar subluxation of the metacarpophalangeal joint of the thumb

Hirata, Hitoshi; Takegami, Kenji; Nagakura, Takeshi; Tsujii, Masaya; Uchida, Atsushi

doi:10.1016/j.jhsa.2004.04.027

Cited by 7 publications

(6 citation statements)

References 8 publications

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“…Other common intraoperative findings include herniation of the metacarpal head through the dorsal capsule and extensor aponeurosis, rupture of ulnar or radial collateral ligaments, and trapping of EPL and/or EPB under metacarpal head. 1,4 The dorsal approach is more commonly used for open reduction because it is more direct, has lower risk of neurovascular injury, and is more versatile to use for repairing the associated injured structures, e.g., dorsal capsule, extensor apparatus, and collateral ligaments.…”

Section: Discussionmentioning

confidence: 99%

An Unusual Case of Volar Dislocation of Thumb Metacarpophalangeal Joint

Man

Lee

2015

Journal of Orthopaedics, Trauma and Rehabilitation

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a b s t r a c tThumb 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. IntroductionVolar thumb metacarpophalangeal (MCP) joint dislocation is rare. There are only a total of 18 cases of volar dislocation of thumb MCP joint published in English and international literature. Most of the cases need open reduction. Nevertheless, by identification of features for difficult reduction and the correct technique, closed reduction in volar dislocation may be successful. Case reportA 37-year-old right-handed, heavy laboured, male mechanic was involved in a road traffic accident, where he fell from his motorcycle that was at a low speed. He landed on the right side of his body. His left hand was also injured. On examination, he was fully conscious and haemodynamically stable. There were multiple abrasions over his right shoulder, hand, and knee. A 10 cm superficial laceration was noted over his right knee, with preservation of the extensor mechanism. On his left hand, there was an abrasion over the radial side of the pulp. Both the metacarpophalangeal (MCP) joint and the interphalangeal joint were swollen, and the MCP joint was held in flexion ( Figure 1). Neurovascular examination was normal. Prominent metacarpal head was palpable dorsally, and the extensor pollicis longus (EPL) was slightly deviated radially. X-rays of the left hand showed volar dislocation of the MCP joint, together with a comminuted minimally displaced fracture over the distal phalanx of the left thumb. There were no obvious interposing sesamoids in the MCP joint ( Figure 2). An emergency operation for debridement and suturing of the knee laceration and reduction of thumb MCP joint was performed under general anaesthesia. An attempt of closed reduction of the thumb dislocation by hyperflexing the dislocated MCP joint with a gentle push on the volar base of the proximal phalanx over the metacarpal head was successful. The radial collateral was stable. The ulnar collateral ligament was found lax but with a solid endpoint. There was no palpable Stener lesion. A thumb spica slab was applied. Postreduction X-ray showed congruent reduction of the MCP joint (Figure 3). The slab was changed to a thumb spica splint the next day, and the patient was discharged.On follow-up at 3 weeks postinjury, there was tenderness over both the MCP joint and the distal phalanx of his left thumb. The

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Section: Discussionmentioning

confidence: 99%

An Unusual Case of Volar Dislocation of Thumb Metacarpophalangeal Joint

Man

Lee

2015

Journal of Orthopaedics, Trauma and Rehabilitation

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“…These findings included no palpable EPL on initial examination, radial or ulnar displacement of the EPL or EPB, interposed sesamoids on x-ray, or paradoxical MCP joint flexion and IP joint extension with attempted MCP extension. 6,11,15 When interposed sesamoids or one of these 3 physical examination findings are present, the likelihood of interposed structures in the joint is high, and consequently the success of closed reduction is low. When these findings are absent, as was the case with both of our patients, an attempt at closed reduction should be made.…”

Section: Discussionmentioning

confidence: 99%

Closed Reduction and Treatment of 2 Volar Thumb Metacarpophalangeal Dislocations: Report of 2 Cases

Beck

Klena

2011

The Journal of Hand Surgery

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“…Dislocations of the joints of the thumb and fingers occur often in the athletic setting, especially to players in sports that involve routine contact of the hands with another player, an object such as a ball, or a fixed surface. 2,8,109 The first MCP joint of the thumb is the most commonly dislocated MCP joint, 55 typically dislocating secondary to a forceful hyperextension mechanism. 56 The lesser MCP joints of the hand, although less frequently dislocated, can dislocate in either a dorsal or volar direction.…”

Section: Considerations Of Individual Jointsmentioning

confidence: 99%

“…2 Similarly, onsite reduction of simple lesser (second through fifth) MCP dislocations, in which the proximal phalanx lies dorsal to the metacarpal head, paralleling the shaft of the metacarpal and involving no soft tissue obstruction, is a relatively easy procedure. [54][55][56] However, in complex dislocations, the reduction attempt often fails due to the buttonholing effect of the soft tissue. 8 These more complex injuries typically require surgical reduction under anesthesia.…”

Section: Considerations Of Individual Jointsmentioning

confidence: 99%

National Athletic Trainers' Association Position Statement: Immediate Management of Appendicular Joint Dislocations

Rozzi

Anderson

Doberstein

et al. 2018

Journal of Athletic Training

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Objective To provide certified athletic trainers (ATs) with recommendations and guidelines for the immediate management of patients with joint dislocations. Background One of the primary responsibilities of ATs is to provide immediate injury care for active individuals. Although ATs are confronted with managing patients who have many kinds of injuries, the onsite management of a joint dislocation presents challenges in evaluation and immediate treatment. The critical concern in managing a dislocation is deciding when a joint can be reduced onsite and when the patient should be splinted and transported for reduction to be performed in the hospital or medical setting. Factors that influence the decision-making process include the following: whether the AT possesses a documented protocol that is supported by his or her supervising physician(s), employer documents, and respective state regulations; the AT's qualifications and experience; the dislocated joint; whether the dislocation is first time or recurrent; the patient's age and general health; and whether associated injuries are present. Recommendations These guidelines are intended to provide considerations for the initial care of specific joint dislocations. They are not intended to represent the standard of care and should not be interpreted as a standard of care for therapeutic or legal discussion.

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Irreducible volar subluxation of the metacarpophalangeal joint of the thumb

Cited by 7 publications

References 8 publications

An Unusual Case of Volar Dislocation of Thumb Metacarpophalangeal Joint

An Unusual Case of Volar Dislocation of Thumb Metacarpophalangeal Joint

Closed Reduction and Treatment of 2 Volar Thumb Metacarpophalangeal Dislocations: Report of 2 Cases

National Athletic Trainers' Association Position Statement: Immediate Management of Appendicular Joint Dislocations

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