MP dislocation of long

fingers

Docteur S.Carms
Centre de la Main, Clinique des Eaux Claires
Guadeloupe
 on of lo n g
i slo ca ti
MP d j u r i es
r e r a r e i n
f i n ger s a

Dorsal dislocations: Most frequent, should be

reduced surgically

Palmar dislocations: Even rarer,

should be reduced surgically
 Palmar dislocation of the MP joint
- First reported case in 1965
by McLaughlin
- Very rare (Less than 20 cases
reported)
- Exact mechanism is not known
(hyperflexion with dorsal
capsule interposition) or
hyperextension with
incarceration of the volar plate
which desinsertion is distal)

McLaughlin HL: Complex "locked" dislocation of the metacarpophalangeal joints. J Trauma 5:683-8, 1965
Palmar dislocation of the MP joint

- Control of the reduction is difficult (may be

unstable)
It seems preferable to reduce under viewing
control, so open reduction should be considered- dorsal
approach seems to be preferred
 a ti on i s most
MP disloc
ofte n d o r s a l

Mostly affect the border digits.

Mechanism is forced hyperextension
Locks the metacarpal head in the palm
with dorsal dislocation of the proximal
phalanx.
 i s d i v i d ed i n
d i sloc ati on
MP
tw o t yp e s

Simple dislocation
Volar plate is not separated from
the proximal phalanx,
The digit is grossly
hyperextended in a resting posture.
Complex dislocation
Separation of the volar plate
from the proximal phalanx and
entrapment of the plate within the
joint
 at om y of MP
Patho-an
dislo ca t i on

Described by Kaplan (1957)

Entrapment of the
metacarpal head by the ulnar
flexor tendons,the dorsal
volar plate, the radial
lumbrical muscle, and the
palmar superficial transverse
ligament.
 at om y of MP
Patho-an
dislo ca t i on

At the little finger

The flexor tendons are
radial and the abductor digiti
minimi is ulnar to the
metacarpal head
 g n os i s i s n ot
Clinical d i a
alwa ys e as y

Pain,
Functional limitation
But deformity may be
minimal
Index (finger) presents with slight hyperextension,
slight ulnar deviation and rotation deformity
Sometimes the metacarpal head is palpable with
dimpling of the palmar skin near the dislocated joint
 i a g n o si s may
d i olo gi ca l d
Ra
b e d i f f i cu lt
a ls o

Lateral views are difficult

to analyse
 i a g n o si s may
d i olo gi ca l d
Ra
b e d i f f i cu lt
a ls o

AP views may display minimal

deformity

in this patient, everyone has noted the fracture of M3, but the
index MP joint is also dislocated
Same patient
 f t en y ou may
Most o
o b s er ve

Overlapping of the
joint lines or
enlargement of the
joint
 f t en y ou may
Most o
o b s er ve

Overlapping of the joint

lines or enlargement of the
joint
(ulnar) deviation of the
finger
 f t en y ou may
Most o
o b s er ve

Overlapping of the joint

lines or enlargement of the
joint
(ulnar) deviation of the
finger
Posterior dislocation
 t men t ?
i v et r ea
n ser v at
Co
Simple dislocations may be
reduce by flexing the wrist and
placing gradual pressure distally
and volarly over the dorsal base
of the proximal phalanx.

If you pull with longitudinal

traction, you will convert a simple
dislocation into a complex one !
 ome message
1 st Tak e h

Do not pull of the finger +++

You will lock the
metacarpal head between
lombricales and FDP
Same principles as for the
thumb MP dislocation apply
 Which approach ?

Farabeuf then Becton suggested

the use of a dorsal approach with:
- Longitudinal section of the
extensor
- Longitudinal section of the
volar plate
- Which allows re-integration
of the metacarpal head which
appears like if you separate
curtains
 Volar approach is preferred

Kaplan has recommended

a volar approach to
control nerves and
arteries, tendons,
lumbricalswhich are
not visible through a
dorsal approach.
 er r ed
s pr ef
ach i
appr o
Volar

The volar plate and proximal phalanx are

reduced with an elevator
Post-op treatment

Immobilisation with the MP in flexion in a

splint for 3-6 weeks

The PIP joint should move freely

Buddy-taping is used for a few days after

splint removal
 Conclusion

Dislocations are rare injuries, with

sometimes a difficult diagnostic.
Inadequate reduction maneuver will be
harmful.
Surgical reduction is recommended with
early protective motion postop
Merci pour votre prsence et votre attention