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Open metacarpophalangeal dislocations; a systematic review a

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Julian Diaz Abele

on 21 February 2014

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Transcript of Open metacarpophalangeal dislocations; a systematic review a

Open metacarpophalangeal dislocations;
a systematic review and case report

by Diaz Abele J., Thibaudeau S., Luc M.
What is the best treatment?
High Health care cost & Time off work (2-10)
Work absenteeism cost >> Treatment cost (11)
MCP joint dislocations
Most commonly singular of the index or little finger
MCP joint resistance
Protective factors
-Location
-Surrounding structures
-Volar plate
-Flexor and extensor tendons
-Sagittal bands
-Intrinsic muscle tendons
Case report
62yo M
10m fall of a tree
No neurovascular injury
No hand fracture
Ipsilateral scapular fracture
Review of the literature
In our literature review of 102 articles
8% Open
4% Open of the 4 long fingers
1st in Canada (5th in the lit)

Findings
- All dorsal, all in males, no hand predominance,
- 4/5 concomitant bone fractures.

Surgical managment
Volar Plate damage
Yes
No
Simple traction and reduction in OR had good results
72-79˚ avg MCP joint ROM
Repair with sutures
90˚ avg ROM
Repair with bony fixation anchors
68˚ avg ROM
Vs
Splinting for 2-3 wks
Improved range of motion
72-79˚ avg MCP joint ROM
Decreased range of motion
Immobilization
or Volar splint
Dorsal splint
69-90˚ avg MCP joint ROM
Our approach
VP repair with sutures
4-0 Ethibond (R) figure eight stitches x 2/VP

Dorsal blocking splint

Adjunctive therapies

(temperature contrast baths, daily scar massage, and nighttime compression gloves with moisturizing cream).

Results
11 days post-op:
59˚ active MCP joint ROM

2 months post-op:
90˚ active MCP joint ROM

Based on our experience and the rare available case report:

1. Concomitant fractures
-Importance of 1˚ and 2˚ survey
2. VP injury
-Intra-operative exploration
-Figure of 8 stitches
3. Dorsal blocking splint
4. Occupational therapy
-Early active and passive ROM exercises
-If possible, adjunct therapies to control the edema and optimize scar tissue

Conclusion
Hand injuries are common
But this injury is uncommon
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