Complete volar metacarpophalangeal joint dislocation of a finger

A complete volar dislocation of the metacarpophalangeal joint of a ring finger occurred in a 31-year-old man and was successfully treated by a closed reduction. We found only six cases of volar metacarpophalangeal joint dislocation reported in the literature all of which needed open reduction.     

摘法整复拇指掌指关节脱位

此次华东地区学习考察，使我们深切感受到了发展社会主义市场经济带来的巨大变化，同时也看到了我省同兄弟省市之间的差距，促使我们思想进一步解放，忧患意识进一步增强，从而加快太原率先发展的步伐。     

Dorsal dislocation of the metacarpophalangeal joint of the thumb: a case report

Dorsal dislocation of the metacarpophalangeal joint of the thumb is uncommon. We report the case of a 15-year-old patient with a complex dislocation of the left thumb who underwent open reduction after several attempts at closed reduction failed. At 2-month follow-up, full range of movement was regained; strength and pinch grip were comparable to that of the uninjured hand. The patient defaulted subsequent follow-up.     

Irreducible dislocation of the metacarpophalangeal joint of the thumb due to tendon interposition

Two cases of irreducible dorsal dislocation of the metacarpophalangeal joint of the thumb are reported. In both cases, there was interposition of the tendon of flexor pollicis longus. Open reduction was required to achieve successful reduction.     

Late presentation of a complete complex thumb metacarpophalangeal joint dislocation: A case report

Metacarpophalangeal (MP) joint injuries and dislocations of the fingers and thumb are not uncommon. They can be classified directionally as either being volar or dorsal, and are further categorized as incomplete, simple complete or complex complete. Complex dislocations are described as dislocations that are irreducible and often require surgical intervention. This is often because tissue has become entrapped within the MP joint, precluding its anatomical reduction. For the thumb MP joint, anatomical structures that may become trapped include the volar plate, sesamoid bones, bony fracture fragments or the flexor pollicis longus tendon. Both dorsal and volar surgical approaches have been described, and their relative merits will be discussed. The unusual case of a late presentation (two months postinjury) of a complex complete dorsal dislocation of the thumb MP joint approached from a dorsal incision is presented.     

Ulnar instability of the metacarpophalangeal joint of thumb

A method of reconstruction of the long standing rupture of ulnar collateral ligament of the thumb is described. Its advantage is the tightness with which the tendon used for repair can be sutured to achieve maximum stability. This has been used in eight patients in the past four years and provided a stable and painless thumb.     

Collateral ligament injuries of the thumb metacarpophalangeal joint

The ulnar and radial collateral ligaments are primary stabilizers of the thumb metacarpophalangeal (MP) joint. Injury to these ligaments can lead to instability and disability. Stress testing is essential to establish the diagnosis. Complete tear is diagnosed on physical examination when the proximal phalanx of the thumb can be angulated ulnarly or radially on the metacarpal head by 30° to 35° with the MP joint in either zero degrees of extension or 30° of flexion. Lack of a firm end point or angulation measuring >15° on stress testing compared with the contralateral thumb MP joint are also indicative of complete tear. Partial ligament injuries may be managed nonsurgically, but complete tears are usually managed surgically. Various techniques are used to reattach the ligament to bone, including suture anchors and, less commonly, repair of midsubstance tears. Options for managing chronic injuries include ligament repair, ligament reconstruction with a free tendon graft, and arthrodesis of the MP joint.     

Locking of the metacarpophalangeal joint of the thumb caused by a fracture fragment of the radial condyle of the metacarpal head after dorsal dislocation

We report a case of a locked thumb metacarpophalangeal joint secondary to metacarpal head fracture. As fractures of the radial condyle are not readily seen in routine X-rays, other imaging modalities, including CT, should be considered if the patient complains of limited extension after hyperextension injury of the thumb.     

拇指籽骨翻转脱位致掌指关节绞锁的诊治

目的:探讨拇指籽骨翻转脱位致掌指关节绞锁的诊断和治疗.方法:对5例掌指关节绞锁患者(男4例,女1例;年龄18～47岁,平均35岁)行闭合手法复位,成功3例,另2例闭合复位失败后行手术切开复位.术中见拇指籽骨翻转脱位,与掌板、拇短屈肌腱一起卡入掌指关节间隙的掌侧,形成绞锁.籽骨复位后,绞锁即得到纠正.结果:5例均获得随访,时间3～34个月,平均15个月.治疗后所有患者局部疼痛症状消失,无红肿,手指感觉正常,掌指关节屈曲35°～60°,平均45°,不影响正常生活及正常工作,治疗后绞锁无复发.结论:拇指籽骨翻转脱位是导致掌指关节绞锁的重要原因之一.     

Motion and morphology of the thumb metacarpophalangeal joint

PURPOSE: To determine the variability in the flexion/extension motion of the thumb metacarpophalangeal (MCP) joint in a normal volunteer population and to determine any correlation between the shape of the thumb metacarpal head, gender, age, thumb interphalangeal (IP) joint range of motion (ROM), and thumb MCP joint ROM in a population of fresh-frozen cadaver arms. METHODS: The ROM of the thumb MCP joints of 100 volunteers (200 thumbs) was measured. The thumb MCP joints of 70 fresh-frozen cadaver arms were examined. Posteroanterior and lateral radiographs were taken of 64 MCP joints. Passive flexion and extension at the MCP and IP joints were measured with a standard goniometer starting at neutral (0 degrees ) with the metacarpal, proximal, and distal phalanges axially aligned. The distance from the volar to the dorsal edge of the articular surface (A) and the radius of curvature of the articular surface (r) of the metacarpal head were measured on the lateral view. The shape of the metacarpal head was given a value using the A/r ratio. Regression analysis was used to determine the correlation between the head shape and joint motion. The thumbs were categorized into a round group (A/r ratio > 1.7) or a flat group (A/r ratio of < 1.7) to facilitate statistical analysis. RESULTS: The volunteer population mean thumb MCP maximum flexion was 77 degrees range, 40 degrees -126 degrees ). Range of motion in hyperextension varied from 0 degrees to 72 degrees, with a mean of 35 degrees. Total ROM was from 55 degrees to 176 degrees, with a mean of 110 degrees. In the cadaver population studied the average MCP joint ROM was 94 degrees (mean flexion, 70 degrees; mean extension, 24 degrees ). The A/r ratio had a range of 1.1 to 2.2. There were 37 round and 27 flat thumb metacarpal heads. Regression analysis showed a significant correlation between metacarpal head shape and ROM; MCP joints with rounder metacarpal heads had greater motion. Round and flat metacarpal heads had significantly different motion arcs averaging 106 degrees and 77 degrees, respectively. Female gender was associated both with significantly greater MCP joint ROM (99 degrees women/87 degrees men) and a significantly higher incidence of round metacarpal heads (66% of women/36% of men). No significant correlation existed between specimen age, MCP, and/or IP joint ROM. CONCLUSIONS: There is a wide range in the magnitude of the thumb MCP joint ROM and the normal shape (round vs flat) of the thumb metacarpal head. A rounder thumb metacarpal head has greater thumb MCP joint ROM than a flatter thumb metacarpal head. Clinically we have found this information helpful in predicting posttraumatic recovery of thumb MCP joint ROM and selecting candidates for and predicting patient satisfaction with thumb MCP joint arthrodesis.     

A metacarpophalangeal joint stabilization splint: the Galindo-Lim thumb metacarpophalangeal joint stabilization splint.

Creation of a splint should allow for maximal functional use of the hand as well as comfort. The design of the Galindo-Lim splint enhances functional use of the hand not only because it stabilizes the MCP joint but also because it does not cross the wrist crease, thus allowing full wrist motion. Independence in the performance of daily activities is easily achieved with the Galindo-Lim splint (Figure 5). The splint is appropriate for patients with a variety of diagnoses, including MCP joint volar plate injuries, collateral ligament injuries, joint hypermobility, and arthritic conditions.     

Ligament injuries of the metacarpophalangeal joint of the thumb

When it comes to injuries of the collateral ligament in the metacarpal-phalangeal joint of the thumb, the best results have proved to be obtainable from primary surgery. Secondary ligament surgery according to Strandel, in its modification by B?uerle and Reill, has its clear-cut indication and ensures restoration of thumb functionality. Arthrodesis is an alternative that should be chosen with generosity.