Purpose
Controversy exists over the pathologic anatomy of irreducible dorsal metacarpophalangeal
(MCP) dislocation. The aim of this work is to develop a cadaveric model of MCP joint
dislocation that closely simulates the clinical situation and to study the structures
around the MCP joint and their contribution to irreducibility of the dislocation.
Methods
Nine fresh-frozen cadaveric specimens were amputated at the radiocarpal joint and
stabilized in a specially formulated fixture. The dislocation was created by an impact
load delivered by a servohydraulic testing machine, at a displacement rate of 1000
mm/s and with a maximum displacement of 60 mm. An irreducible dislocation was successfully
created in 6 index fingers. An attempt at closed reduction was followed by a dissection
of the dislocated joint.
Results
In the 6 examined specimens, the flexor tendons were ulnar to the joint in all cases,
the radial digital nerve was superficial (5 cases) or radial (5 cases) to the metacarpal
head, and the lumbrical was usually radial (5 of 6 cases) to the joint. Division of
the superficial transverse metacarpal ligaments, natatory ligaments, flexor tendons,
or lumbricals does not aid reduction of the dislocation. Division of the volar plate
was necessary for reduction of the dislocation in all 6 cases, whereas division of
the deep transverse metacarpal ligaments does not allow reduction of the dislocation.
Conclusions
We present a model for creating an irreducible MCP joint dislocation using an impact
load that simulates the clinical situation. The volar plate is the primary structure
preventing reduction of the dislocation. Division of the deep transverse metacarpal
ligament is not effective in reducing the dislocation. The flexor tendons, lumbricals,
superficial transverse metacarpal ligament and natatory ligaments do not contribute
to irreducibility. The anatomy of the structures surrounding the MCP joint is variable,
and careful dissection to prevent iatrogenic injuries is mandatory.
Key words
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References
- Dorsal dislocation of the metacarpophalangeal joint of the index finger.J Bone Joint Surg. 1957; 39A: 1081-1086
- Complex dislocation of the metacarpophalangeal joint.J Bone Joint Surg. 1973; 55A: 1480-1486
- Complex dislocation of the metacarpo-phalangeal joint of the index finger: a comparison of the surgical approaches.J Hand Surg. 1988; 13B: 466-468
- Complex dorsal dislocation of the metacarpophalangeal joint, the deep transverse metacarpal ligament as a barrier to reduction.Iowa Ortho J. 1988; 8: 9-12
- Complex “locked” dislocation of the metacarpophalangeal joints.J Trauma. 1965; 5: 683-688
- Phalangeal injuries.in: Trumble T.E. Budoff J.E. Hand surgery update. 4th ed. American Society of Surgery of the Hand, Rosemont, IL2007: 1-19
- Intraarticular injuries of the metacarpophalangeal and carpometacarpal joints.in: Berger R.A. Weiss A.C. Hand surgery. Lippincott Williams & Wilkins, Philadelphia2004: 176-179
- Complex dorsal metacarpophalangeal joint dislocation caused by interosseous tendon entrapment: case report.J Hand Surg. 2008; 33A: 555-557
- Atlas of hand anatomy and clinical implications.in: Mosby, St. Louis, MO2004: 228-229
- Structural and dynamic basis of the hand surgery.in: J.B. Lippincott, Philadelphia1979: 23
- Closed dislocation of the metacarpophalangeal joint of the index finger.J Bone Joint Surg. 1967; 49A: 1579-1586
- An isolated, closed, complex dislocation of the metacarpophalangeal joint of the long finger: a unique case.J Hand Surg. 1986; 11A: 558-561
- A simplified technique for treating the complex dislocation of the index metacarpophalangeal joint.J Bone Joint Surg. 1975; 57A: 698-700
- Percutaneous technique for reduction of complex metacarpophalangeal dislocations.Ann Plast Surg. 2004; 52: 562-565
Article info
Publication history
Published online: August 25, 2009
Accepted:
June 2,
2009
Received:
December 30,
2008
Footnotes
No benefits in any form have been received or will be received related directly or indirectly to the subject of this article.
Identification
Copyright
© 2009 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.
