Dislocations Of The Metacarpophalangeal Joint Of The Thumb In Children

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Dislocations Of The Metacarpophalangeal Joint Of
The Thumb In Children

• R.Maheshwari, H.Sharma, R.D.D.Duncan
• Department of Orthopaedics
• Royal Hospital for Sick Children
• Glasgow, United Kingdom

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Aims

• Report large series of thumb MCPJ dislocations in
  children
• Correlate radiological presentation with
  treatment

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Classification (Farabeuf)

• Incomplete
• Simple complete volar plate ruptured but not
  interposed. Joint usually extended 90
• Complex complete volar plate ruptured and
  interposed, phalanx and metacarpal parallel.

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Materials And Methods

• Retrospective casenote review
• 37 cases over 15 years
• Radiographs available for 23 cases
• Mean age 7.3 years (range 3-13)
• 29 boys, 8 girls
• Right side 21, left 16
• Presentation 34 new, 2 at one week, 1 at 2 weeks
  

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Results-I

• Dorsal dislocation in 36 (97), 1 volar
• Closed reduction - 33
• Open reduction - 4, (1-4 unsuccessful attempts)
• -Approaches volar (2), dorsal (1) and
  ulnar (1)
• -Blocks to reduction
• volar plate, FPL, capsule and collateral ligament
  (1)
• volar plate (1)
• no intraarticular soft tissue obstruction (2)
• Post op immobilization in spica cast 3/52

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Results-II

• Follow up 2 weeks-6 months
• Most had good clinical result
• Complications
• mild stiffness (2)
• Instability of UCL requiring reconstruction (1)
• No infection, recurrent dislocation

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Results III

• Radiological review
• Suggesting Simple complete dislocations in 23
• Closed reduction 19
• Open reduction 4
• Volar plate interposition in 2

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Conclusions

• Closed reduction usually successful
• Simple complete types may require open
  reduction and may actually be complex complete
• Open reduction may be performed by dorsal or
  volar approach

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