Metacarpophalangeal and Interphalangeal Joint Dislocation

Abstract

A 15-year-old male sustained an index finger dorsal fracture dislocation of his metacarpophalangeal (MCP) joint. Multiple closed reduction attempts were made in the emergency room but were ultimately unsuccessful. A simple dislocation can become irreducible if multiple attempts at closed reduction are performed via straight traction. The patient was then transferred to a pediatric hospital for further care. Due to the complex nature of this injury, the patient was brought to the operating room. An irreducible dorsal dislocation can be approached volarly or dorsally depending on surgeon preference and concurrent injuries. The dorsal fracture fragment necessitated a dorsal approach for the open reduction and fixation, which also served to avoid the volar neurovascular bundle in the approach to the MCP joint. The dislocated joint was reduced after releasing the volar plate, which was interposed. The metacarpal head fracture was then stabilized with two 1.3 mm screws. The patient was briefly splinted postoperatively, and early range of motion exercises were initiated within 2 weeks of the injury. The patient regained functional motion within a few weeks of his injury and the fracture healed uneventfully.