Purpose
Complex metacarpophalangeal (MCP) dislocations require open surgical reduction, but
surgeons disagree about the best surgical approach. We hypothesized that a dorsal
approach would require less operative time than would a volar approach and result
in a decreased need for a secondary approach.
Methods
We performed a retrospective chart review of all isolated irreducible dorsal MCP dislocations
treated at 2 level 1 trauma centers between 2005 and 2015. We recorded the initial
surgical approach (volar or dorsal), total operative time, and whether the surgeon
used a second surgical approach. Operative times for initial volar approach versus
initial dorsal approach, hand surgeon versus non-hand surgeon, and thumb versus other
digits were compared using the 2-tailed Student t test. We used Fisher exact test to compare the need for a second approach between
the volar and dorsal approach groups.
Results
A total of 21 patients (22 digits) with MCP dislocations required surgical reduction.
Average operative time was longer for the 14 patients who underwent the initial volar
approach (70 minutes) than for the 7 who underwent an initial dorsal approach (45
minutes). Six of the 14 MCP joints approached volarly (42%) required a second dorsal
approach. None of the 7 patients in the dorsal group required a second approach.
Conclusions
Using a dorsal approach to reduce complex MCP dislocations reduces operative time
and decreases the need for a secondary approach.
Type of study/level of evidence
Therapeutic IV.
Key words
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References
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Article info
Publication history
Published online: July 09, 2016
Accepted:
May 30,
2016
Received:
January 18,
2016
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
Copyright © 2016 by the American Society for Surgery of the Hand. All rights reserved.
