Complex dorsal metacarpophalangeal joint dislocation associated with proximal metacarpal fracture: case report and review of the literature

• Published in: International journal of surgery case reports 2024-05, Vol.118, p.109532, Article 109532
• Main Authors: Bouya, Ayoub, Bennis, Azzelarab, Zaddoug, Omar, Benchakroun, Mohammed, Zine, Ali, Bouabid, Salim
• Format: Article
• Language: English
• Subjects: Case Report; Complex; Dislocation; Dorsal metacarpophalangeal joint; Fracture; Metacarpal bone
• ISSN: 2210-2612; 2210-2612
• DOI: 10.1016/j.ijscr.2024.109532

Complex dorsal metacarpophalangeal joint (MCPJ) dislocations are uncommon injuries that mainly affect the index finger and are typically caused by a fall on an outstretched hand. It is exceptional for complex MCPJ dislocation to coexist with a distal fracture of the corresponding metacarpal bone. The authors report a case of a 23-year-old man presented to the emergency, with a complex dorsal metacarpophalangeal joint dislocation of the index associated with a distal metacarpal fracture confirmed by imaging. The patient had an open reduction and internal fixation of the proximal metacarpal fracture. The results were satisfying. Dorsal MCP joint dislocations are rare, primarily affecting the index and little fingers, and are typically caused by a fall on an outstretched hand. Complex dislocations, characterized by irreducibility, involve structures forming a “noose” around the metacarpal head. Fractures associated with these dislocations are uncommon. Early diagnosis is crucial for better long-term functional outcomes. Radiographic imaging, including three different views, is necessary for accurate diagnosis. Surgery is usually required, with different approaches depending on the case. Arthroscopic techniques can be used when reduction is challenging. Timely surgical intervention yields the best results. Stiffness, osteoarthritis, osteonecrosis, and growth arrest in pediatric cases are the main complications. Complex dorsal metacarpophalangeal joint (MCPJ) dislocations are rare. Open reduction is typically necessary for optimal outcomes. Complications such as stiffness, osteoarthritis can arise, emphasizing the importance of accurate diagnosis and appropriate management. •Complex dorsal metacarpophalangeal joint (MCPJ) dislocations are rare injuries predominantly affecting the index finger, usually resulting from a fall onto an outstretched hand.•Attempts at reduction without an accurate diagnosis are unnecessary and could even be hazardous.•Open reduction is generally required to achieve the best outcomes. Potential complications include stiffness and osteoarthritis, highlighting the need for precise diagnosis and proper management.•Prompt and accurate diagnosis is essential for improving long-term functional outcomes. Emergency physicians should be aware that complex MCPJ dislocations necessitate surgical intervention, and attempts at closed reduction may worsen the situation.