abstracts

Irreducible Dorsal Dislocation of the Index MCP Joint with Superimposed Sesamoid Bone

James Thomas, D.O., Nader Paksima, D.O.

Introduction
Dorsal dislocation of the Metacarpophalangeal (MCP) joint is common.  Irreducible dorsal dislocation of the MCP joint however, are rare and require open reduction.  Any dislocation that requires operative reduction is by definition, a complex dislocation.  

Case Presentation
We present a 79-year-old (y.o.) right hand dominant (RHD) male who presented with a chief complaint of an inability to use his left index finger after tripping while walking.  Radiographs revealed dorsally dislocated left index MCP with a superimposed sesamoid bone.  He was diagnosed with an irreducible left index finger MCP dislocation, after failure of closed reduction in the ED.  The patient was operated on, using the dorsal approach to incise the volar plate longitudinally

Discussion
The presence of a sesamoid bone within the joint space is pathognomonic for an irreducible dorsal MCP dislocation. Irreducible dorsal MCP dislocations are rare and require operative reduction.

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References

  1. Becton, J. L., J. D. Christian, Jr., H. N. Goodwin, and J. G. Jackson, 3rd. "A Simplified Technique for Treating the Complex Dislocation of the Index Metacarpophalangeal Joint | The Journal of Bone & Joint Surgery." A Simplified Technique for Treating the Complex Dislocation of the Index Metacarpophalangeal Joint | The Journal of Bone & Joint Surgery. The Journal of Bone and Joint Surgery, July 1975. Web. 24 July 2016.
  2. DeCoster, Thomas A., Deborah McGrew, and George E. Omer. "Complex Dorsal Dislocation of the Metacarpophalangeal Joint: The Deep Transverse Metacarpal Ligament as a Barrier to Reduction."The Iowa Orthopaedic Journal. U.S. National Library of Medicine, 1988. Web. 25 July 2016.
  3. Dennison, David G. "Hand – Finger Dislocations and Ligament Injuries." Key Topics in Orthopaedic Trauma Surgery (1999): 80-81. Web.
  4. Durakbaza, Oguz, and Bulent Guneri. "The Volar Surgical Approach in Complex Dorsal Metacarpophalangeal Dislocations." The Volar Surgical Approach in Complex Dorsal Metacarpophalangeal Dislocations. Elsevier, June 2009. Web. 24 July 2016.
  5. Kaplan, Emanuel B. "Dorsal Dislocation of the Metacarphophalangeal Joint of the Index Finger." The Journal of Bone and Joint Surgery (1957): 1081-086. 1957. Web. 22 July 2016.

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