Open Metacarpophalangeal Dislocations: Literature Review and Case Report

Abstract

Background Open dorsal metacarpophalangeal joint dislocations are rare. We report the case of a 62-year-old man who fell from a height of 10 m onto his left outstretched hand and presented to us with four open dorsal metacarpophalangeal joint dislocations. We review the literature and present our case to elucidate the best treatment protocol for open dorsal metacarpophalangeal joint dislocations. Methods A systematic review was conducted using MEDLINE, Embase, and PubMed from 1946 to present. Publications were found using key terms and crossreferencing. Detail on patient demographic, presentation, mechanism of injury, injury management, and outcome were collected. Results A total of 102 articles of metacarpophalangeal joint dislocation (excluding thumb dislocations) were identified. Of these, only four were of open dorsal metacarpophalangeal joint dislocation involving the four long fingers. Open dislocation of the metacarpophalangeal joint in these studies showed no hand predominance, nor association with hand dominance. Conclusion Open dorsal metacarpophalangeal joint dislocations of the four long fingers are unusual. Based on the available case reports and our experience, we suggest addressing this injury intraoperatively with minimal delay. Most cases will be associated with volar plate injury, and we encourage its repair with figure-of-eight stitches. Postoperatively, we suggest a dorsal blocking splint for 2 weeks followed by occupational therapy consisting of passive and active range of motion (ROM) exercises and adjunctive therapies to control edema and optimize scar tissue. Inadequate management of such injuries could be highly detrimental to hand function.

Open Dislocation Injury of the Metacarpophalangeal Joints III–V: Case Report

“…Open MCPJ dislocation injury is a rare condition accounting for a relative portion of 10.8% of all references in the literature, and in 63.6% of them, more than 1 MCPJ is involved (1 reference: MCPJs II and III, 2 references: MCPJs II–IV, 5 references: MCPJs II–V). 9 To our knowledge, our presented case is the first report in the literature that describes an open MCPJ dislocation injury in the dorsal direction involving the MCPJs III–V. To avoid post-traumatic instability in the MCPJ, potentially leading to post-traumatic cartilage destruction and resulting in osteoarthritis, surgical revision with the restoration of joint anatomy should be done as soon as possible.…”

“… 1 Hence, the volar approach is more recommended for treatment of closed MCPJ dislocation injury in the dorsal direction than the dorsal approach; it offers the surgeon more direct visual access to the pathologies involving the volar neurovascular bundles and possible flexor tendon entrapment, facilitates the surgical release, and enables refixation of the volar fibrocartilaginous plate, if necessary. 1 , 5 , 9 , 10 However, refixation of the VFCP is controversial; it can lead to joint stiffness if done, and not all patients report instability if refixation was not done. 9 These therapeutic approaches are also applicable for open dislocation injuries independently of involvement of 1 or more MCPJs, and reduction should be done through the open wound.…”

“… 1 , 5 , 9 , 10 However, refixation of the VFCP is controversial; it can lead to joint stiffness if done, and not all patients report instability if refixation was not done. 9 These therapeutic approaches are also applicable for open dislocation injuries independently of involvement of 1 or more MCPJs, and reduction should be done through the open wound. Postoperative care includes immobilization in a dorsal blocking splint protecting against hyperextension and allowing a full range of active flexion (ie, intrinsic-plus), and physiotherapy should start 2–3 weeks after surgery.…”

“…Postoperative care includes immobilization in a dorsal blocking splint protecting against hyperextension and allowing a full range of active flexion (ie, intrinsic-plus), and physiotherapy should start 2–3 weeks after surgery. 5 , 9 …”

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

“…Metacarpophalangeal joint dislocations are rare because of the strong connective tissue support around the joints and the joint's basal location in the hand [6]. A dislocation is considered to be simple when it is easily reducible without open surgical procedures and complex when open reduction is necessary [1].…”