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.     

Complex dislocation of the metacarpophalangeal joint of the little finger

Complex dislocation of the little finger metacarpophalangeal joint is very rare. In the English literature, we have found only ten published cases. The condition usually requires open reduction, and most authors advocate a dorsal incision. We report two additional cases, treated by the volar approach, which makes a direct access to the incarcerated structures possible.     

Isolated complex dislocation of the metacarpophalangeal joint of the third finger

Two unusual cases of isolated closed complex dislocation of the metacarpophalangeal joint of the third finger are presented. The single most important element preventing reduction was interposition of the volar plate between the proximal end of the phalanx and the head of the metacarpal, but the deep transverse ligament was also intimately involved in the entrapment mechanism. Such dislocations require open reduction as in the two cases presented, and we found the dorsal approach to be simple and effective.     

Palmar dislocation of the radiocarpal joint

Radiocarpal dislocation, with or without damage to the radial styloid process or to the distal radial rim, is extremely rare. Review of the literature reveals much confusion on the proper classification of radiocarpal dislocations or fracture-dislocations. A case of radiocarpal dislocation is reported, the classification is discussed, and a critical review of earlier reports is presented.     

Palmar dislocation of the proximal interphalangeal joint

Fifteen patients with palmar dislocations of the proximal interphalangeal (PIP) joint were reviewed 6 to 49 months after treatment (average 17.8 months). Disruption of the extensor mechanism, palmar plate, and one collateral ligament was found in all patients. The loss of static and dynamic joint support caused palmar subluxation, malrotation, and a boutonnière deformity. Two dislocations were irreducible, and three were associated with dorsal avulsion fractures from the middle phalanx. The serious nature of the injuries from this dislocation was initially unrecognized, and most patients were casually treated; delay from injury to referral averaged more than 11 weeks. Twelve of the 15 required surgery for joint reduction and tendon and ligament repair; three treated earlier were managed by closed reduction and percutaneous pinning. Joint alignment, comfort, and stability were restored, and all returned to full activities including heavy labor. However, a full range of PIP motion was not recovered in any case.     

Volar dislocation of the metacarpophalangeal joint of the ring finger. Report of two cases.

Volar dislocation of the metacarpophalangeal joint of the finger is a rare injury. Two cases of an isolated volar dislocation of the ring finger metacarpophalangeal joint are reported. The dislocation was treated successfully by closed reduction shortly after injury in both cases. Closed reduction should be attempted in all cases of this injury because successful reduction may be possible.     

Complex dislocation of the index metacarpophalangeal joint in children

Four cases of complex dislocation of the index metacarpophalangeal joint prior to skeletal maturity were reviewed. Despite the generalized laxity present in these children, none of the dislocations could be anatomically reduced by closed methods. Two patients had a concomitant osteochondral fracture from the ulnar side of the metacarpal epiphysis; one subsequently developed a lesion similar to an epiphyseal osteochondroma. One patient developed ischemic necrosis leading to premature growth arrest; a shortened metacarpal, and a deformed metacarpal head. The possibility of vascular damage must be considered in the skeletally immature patient, since the epiphyseal and physeal circulation may be compromised by either the dislocation or exposure for the reduction.     

Synovial chondromatosis of the metacarpophalangeal joint of the ring finger

Synovial chondromatosis is an uncommon condition, characterized by multinodular cartilagineous proliferation of the joint synovium. There are only a few case reports of synovial chondromatosis involving the hand in the literature. A case of synovial chondromatosis of the ring finger is reported in this paper.     

Complete dorsal dislocation of the metacarpophalangeal joint of the thumb

In the pathology of simple complete dislocation involving the metacarpophalangeal joint of the thumb, whether or not the palmar plate is interposed within the joint is controversial. Nine cases of complete dorsal dislocation of the joint were reviewed, and cadaver dissection was performed to study the pathology of this injury. Eight of the nine patients were seen within 4 days of injury and treated successfully by closed manipulation. One patient treated 7 days after the injury required open reduction. We were able to reproduce the pathological anatomy of the dislocation, wedging of the palmar plate in the joint of the cadaver. In this cadaver and in all clinical cases, radiographs showed a complete dislocation with an increased distance between the palmar edge of the base of the proximal phalanx and the metacarpal head, indicating an interposition of the palmar plate. Our study suggests that in simple complete dislocations of this joint, the palmar plate is interposed between the displaced bones. Received: 16 December 1997     

Palmar dislocation of the radio-carpal joint: a case report

Radio-carpal joint dislocation, with or without fracture of the radius, is an uncommon injury; only 21 cases have previously been reported. Successful treatments of closed reduction and surgery have also been reported. A 35-year-old right-handed man was injured in a traffic accident and taken to an emergency room of a hospital, where radiographic examination showed a right palmar radio-carpal joint dislocation. Three days after injury, the patient was transferred to our department at Tokyo Medical University, Tokyo. We performed percutaneous pin fixation to maintain the position of his reduced radio-carpal joint. Two years postoperatively, radiographic examination showed a complete union of the avulsion fracture of the radius and a reduction of the joint. He had no marked disturbance in his daily activities apart from a slight pain while working. He had no limitation on the range of motion of the wrist joint and his grip strength was 41.6 kg. He returned to work 3 months after injury.