Question

25 year-old female struck in the left hand by a football. Presents with pain, visible deformity, and the Xray below. What are the next step(s) in management?

Answer

Dorsal Metacarpophalangeal (MCP) Dislocation

• MCP dislocations typically occur secondary to a hyperextension injury
• Two categories of dislocations
  • Simple; joint spaces closely opposed and treated by closed reduction
  • Complex; volar plate is entrapped dorsal to metacarpal head with lumbricals and tendons interposed between joint surfaces; treated by operative reduction
• To reduce a simple dislocation:
  • Provide a digital ring-block for analgesia
  • Maximally hyperextend the proximal phalanx with wrist in flexion
  • Push base of proximal phalanx distally while bending the joint into flexion
  • Test neurovascular integrity and joint-stability post-reduction by ranging the joint through a full range of motions
  • Place in thumb spica splint and refer to hand specialist

References

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