Arthroscopic Management of Metacarpophalangeal Articular Fractures

Abstract

Articular fractures involving the metacarpophalangeal joints of the thumb and digits are relatively common injuries in the hand that require particular attention to anatomic reduction in order to minimize late complications that can include stiffness/contracture, malunion, and development of late post-traumatic arthrosis. Careful assessment by the specialized hand surgeon is often needed to determine what type of treatment is needed for certain complex articular fractures at the MCP joint which may also include ligamentous avulsion fractures.

Despite appropriate treatment, severe MCP injuries may develop arthritis whose treatment may depend largely on the age, occupation, and activity demands of the patient. Avoiding post-traumatic arthrosis is the optimal goal and can best be achieved with arthroscopic means since the joint cartilage is assessed and reduced, in conjunction with the actual bony fracture as the latter is only seen on fluoroscopy or plain X-ray. For post-traumatic arthritis, total joint arthroplasty is an option but tends to be less successful than for osteoarthritis indications. Arthrodesis in position of function is rarely needed but may be an option in the thumb MCP joint.