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Metacarpophalangeal Joint Dislocation

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Other Names

  • MCP Joint Dislocation
  • MCP Dislocation

Background


Pathophysiology

  • Typically a fall on outstretched hand with hyperextension mechanism
  • Dorsal dislocation more common than volar dislocation

Risk Factors

  • Unknown

Differential Diagnosis


Clinical Features

  • General: Physical Examination Hand
  • Inspection: Deformity generally obvious
    • Dorsal: hyperextended proximal phalanx with flexion at PIPJ
    • Volar: loss of extension, dorsal skin depression

Evaluation


Classification

  • Anatomic
    • Volar
    • Dorsal (more common)
  • Complexity
    • Simple: no interposition of Volar Plate, sesamoids
    • Complex: interposition of volar plate and/or sesamoids
      • metacarpal head becomes entrapped by displaced ligaments
    • Kaplan's lesion: rare, metacarpal head buttonholes volarly into palm
      • Most common in index finger

Management

Acute Management

  • Reduction: May reduce with just traction
  • Dorsal dislocation:
    • Relax flexor tendons by flexing wrist
    • Then hyperextend the joint and apply dorsal pressure over the roximal phalanx in distal and volar direction
  • Volar dislocation:
    • Less common, harder to reduce with closed reduction
    • Hyperflex the joint and then apply traction and extend finger
    • Guide proximal phalanx into place
  • Splint with MCP joint in flexion

Nonoperative

  • Closed reduction for simple dislocations

Operative

  • Open reduction for complex dislocations

Return to Play

  • Needs to be updated

Complications


See Also


References


Created by:
John Kiel on 18 June 2019 23:09:24
Authors:
Last edited:
28 October 2020 13:40:51
Categories: