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Metacarpo-phalyngeal joint dislocation.pptx
MCP dislocations are dislocations of the metacarpophalangeal joint, usually dorsal, caused by a fall and hyperextension of the MCP joint. Diagnosis can be made clinically and confirmed with x-rays. Treatment is typically closed reduction for simple dislocations, while open reduction is needed for complex dislocations with soft tissue interposition blocking closed reduction.
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Metacarpo-phalyngeal joint dislocation.pptx
- 2. SUMMARY • MCP DISLOCATIONSARE A DISLOCATION OF THE METACARPOPHALANGEAL JOINT, USUALLY DORSAL, CAUSED BY A FALL AND HYPEREXTENSION OF THE MCP JOINT. • DIAGNOSIS CAN BE MADE CLINICALLY AND IS CONFIRMED BY ORTHOGONAL RADIOGRAPHS. • TREATMENT IS CLOSED REDUCTION UNLESS SOFT TISSUE INTERPOSITION BLOCKS REDUCTION, IN WHICH CASE OPEN REDUCTION IS INDICATED.
- 3. ANATOMIC LOCATION • DORSALDISLOCATIONS ARE MOST COMMON • INDEX FINGER IS MOST COMMONLY INVOLVED • THUMB IS SECOND MOST COMMON DIGIT INVOLVED
- 4. ETIOLOGY • PATHOPHYSIOLOGY • MECHANISMOF INJURY • USUALLY A FALL ON OUTSTRETCHED HAND LEADING TO HYPEREXTENSION OF MCP JOINT • LEADS TO AVULSION OF THE VOLAR PLATE FROM METACARPAL NECK
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- 6. CLASSIFICATION ANATOMIC CLASSIFICATION OFMCP DISLOCATION Volar Results from hyperextension or hyperflexion injury Dorsal Most commonResults from hyperextension injury
- 7. COMPLEXITY OF MCPDISLOCATION Simple (subluxation) No interposition of volar plate and/or sesamoid Base of proximal phalanx remains in contact with the metacarpal head Complex (complete) Interposition of volar plate and/or sesamoids Metacarpal head becomes entrapped by -displaced natatory ligaments distally -superficial transverse metacarpal ligament proximally Kaplan's lesion (rare) -most common in index finger -metacarpal head buttonholes into palm (volarly) -volar plate is interposed between base of proximal phalanx and metacarpal head
- 8. PRESENTATION • PHYSICAL EXAM •DEFORMITY SEEN ON INSPECTION DEPENDS ON TYPE OF DISLOCATION • DORSAL DISLOCATION • SIMPLE • HYPEREXTENSION OF PROXIMAL PHALANX ON METACARPAL HEAD • FLEXION OF PIP JOINT • COMPLEX • BAYONET POSITIONING OF PROXIMAL PHALANX (DORSAL TO METACARPAL SHAFT) • SKIN DIMPLING IN PROXIMAL PALMAR CREASE • VOLAR DISLOCATION • EXTENSOR LAG PRESENT • DORSAL SKIN DEPRESSION FOUND PROXIMAL TO BASE OF PROXIMAL PHALANX
- 9. IMAGING • RADIOGRAPHS • RECOMMENDEDVIEWS • AP • LATERAL • BEST VIEW TO SEE DISLOCATION • OBLIQUE • FINDINGS • COMPLEX DISLOCATION • JOINT SPACE WIDENING MAY INDICATE INTERPOSITION OF VOLAR PLATE • ENTRAPMENT OF SESAMOID IN MCP JOINT IS DIAGNOSTIC OF COMPLEX DISLOCATION
- 10. • NONOPERATIVE • CLOSED REDUCTION •INDICATIONS • SIMPLE DISLOCATIONS • OPERATIVE • OPEN REDUCTION • INDICATIONS • COMPLEX DISLOCATIONS
- 11. COMPLICATIONS • JOINT STIFFNESS •DUE TO SOFT TISSUE TRAUMA AT TIME OF INJURY OR PROLONGED IMMOBILIZATION • POST-TRAUMATIC ARTHRITIS OR OSTEONECROSIS • DUE TO REPEATED ATTEMPTS AT CLOSED REDUCTION, PROLONGED DISLOCATION, TRAUMATIC OPEN REDUCTION • PREMATURE PHYSEAL CLOSURE • RARE