Case Report
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World J Orthop. Jan 18, 2014; 5(1): 62-66
Published online Jan 18, 2014. doi: 10.5312/wjo.v5.i1.62
Isolated dorsal approach for the treatment of neglected volar metacarpophalangeal joint dislocations
Hakan Başar, Mustafa Erkan İnanmaz, Kamil Çağrı Köse, Cihangir Tetik
Hakan Başar, Mustafa Erkan İnanmaz, Kamil Çağrı Köse, Department of Orthopaedic and Traumatology, Sakarya Training and Research Hospital, 54100 Sakarya, Turkey
Cihangir Tetik, Department of Orthopaedics and Traumatology, Acibadem Maslak Hospital, 34093 Istanbul, Turkey
Author contributions: Başar H and Tetik C designed the report; İnanmaz ME and Tetik C were attending doctors for the patients; Başar H performed surgical operation; İnanmaz ME was performed image diagnosis; Başar H organized the report; and Başar H and Köse KÇ wrote paper.
Correspondence to: Hakan Başar, MD, Department of Orthopaedic and Traumatology, Sakarya Training and Research Hospital, No. 156/25 Serdivan, 54100 Sakarya, Turkey. hbasar80@hotmail.com
Telephone: +90-505-4418608 Fax: +90-264-3177070
Received: September 2, 2013
Revised: October 29, 2013
Accepted: November 15, 2013
Published online: January 18, 2014
Processing time: 140 Days and 10 Hours
Abstract

Here, we present the clinical and radiological results of three neglected volar metacarpophalangeal dislocations in 2 patients, which were treated with open reductions 10 and 24 mo after the dislocations. There was a mean of a 20° (range 10°-30°) limitation of extension and a 53.3° (range 30°-70°) limitation of flexion preoperatively. Postoperatively, there was no limitation of extension (at 8 and 12 mo) in any of the fingers. In terms of flexion, one finger had full function, one had a 10° and the last one had a 30° limitation of flexion. Two of the fingers presented anesthesia preoperatively, which improved to hypesthesia postoperatively. One finger had hypesthesia, which improved postoperatively. During surgery, a ruptured dorsal capsule was found to have interposed into the joint, making closed reduction impossible. Our experience with these two patients demonstrated that, even in neglected cases, open reduction using an isolated dorsal approach may result in satisfactory clinical and radiological outcomes.

Keywords: Metacarpophalangeal dislocation; Neglected dislocation; Surgical treatment; Dorsal surgical approach; Metacarpophalangeal dislocation rehabilitation

Core tip: Irreducible complex metacarpophalangeal (MP) dislocations are rare. Volar MP dislocations are very rare. There are no data in the literature reporting volar MP dislocations. We also observed neglected volar MP dislocations in our study. A dorsal or volar approach can be applied toward the surgical treatment of MP joint dislocations. In this study, we observed that isolated dorsal open reduction and K wire fixation results in a successful functional outcome in neglected volar MP dislocations. Volar exposure was not necessary for reduction and stabilization.