UMEM Educational Pearls

Title: What's the Diagnosis? Image by Dr. Christina Tupe

Posted: 10/7/2013 by Haney Mallemat, MD
Click here to contact Haney Mallemat, MD

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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