Management of a Rare Case of Complex and Irreducible Dislocation of the Metacarpophalangeal Joint in the Little Finger - A Case Report.

Abstract

Introduction: Pure dislocations of the digits of the hand are predominantly dorsal and typically result from a forceful hyperextension of the metacarpophalangeal joint. This report aims to present a rare case of a complex and irreducible dislocation of the metacarpophalangeal joint of the little finger with an emphasis on the management strategy for a successful outcome.

Case report: A 48-year-old male presented to the Emergency Department after sustaining an injury to his left hand during a soccer match. On clinical examination, he exhibited pain, deformity, and a significant restriction of motion in the little finger. Radiological evaluation confirmed a dorsal dislocation of the metacarpophalangeal joint. Two attempts at closed reduction were unsuccessful, and the patient was subsequently taken to surgery. Using a volar approach, the A1 pulley was released. Reduction was challenging due to the volar plate's dorsal displacement, where it became trapped between the proximal phalanx and the metacarpal head. Using a Freer elevator as a lever and applying gentle traction and flexion, the proximal phalanx was reduced through the volar plate. The volar plate was then repaired with absorbable sutures. To stabilize the finger, a dorsal K-wire was placed at a 45° angle and removed 15 days later. Following removal of the K-wire, the patient began progressive mobilization of the finger through its full range of motion. Two months postoperatively, the patient regained full, pain-free mobility and returned to his pre-injury activities.

Conclusion: Although metacarpophalangeal joint dislocations can be easily diagnosed, their management should not be underestimated. In cases where closed reduction is unsuccessful, clinicians should consider the possibility of complex dislocations, which often necessitate open reduction.