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Background
- Also known as the MCP joint
- Usually forces that rupture volar plate cause dorsal dislocation
Clinical Features
- Mechanism: hyperextension
- Finger pain/deformity
Differential Diagnosis
- Finger dislocations
- Thumb dislocations
- Hand dislocations
- Distal finger
- Other finger/thumb
- Hand
- Wrist
- General
Evaluation
Types
- Simple: subluxation
- Joint appears hyperextended to 60-90 deg
- Complex: dislocation
- MCP joint is in moderate hyperextension with metacarpal head prominent in palm
- Volar plate is interposed in MCP joint space
- X-ray may show seasamoid within joint space (pathognomonic)
- Closed reduction is not possible
Management
Reduction
- Traction alone may convert simple MCP dislocation may convert it to a complex dislocation [1]
- Dorsal dislocation
- Flex the wrist to relax the flexor tendon
- Hyperextend the joint
- Apply pressure over dorsum of proximal phalanx in distal and volar direction
- Volar dislocation
- Rare, will likely need open reduction
- If attempting closed reduction, push finger into the MCP joint and then hyperflex joint
- After hyperflexing, pull traction and extend finger, using thumbs to guide proximal finger into place [2]
- Splint with MCP joint in flexion
- Refer to hand surgeon within 2 weeks
Disposition
See Also
External Links
References
- ↑ Horn A. Management of Common Dislocations. In: Roberts and Hedges' Clinical Procedures in Emergency Medicine. 6th ed. Philadelphia, PA: Elsevier; 2014.
- ↑ Davenport M. Procedures for orthopedic emergencies. In: Bond M, ed. Orthopedic Emergencies: Expert Management for the Emergency Physician. Cambridge: Cambridge University Press; October 31, 2013.