The volar surgical approach in complex dorsal metacarpophalangeal dislocations.

OBJECTIVE: To describe the surgical treatment of complex dorsal metacarpophalangeal dislocations, emphasising the volar approach.

METHODS: Seven cases of isolated, closed, complex dorsal metacarpophalangeal dislocation, treated surgically using the volar approach, were retrospectively evaluated. The median follow-up period was 91 months.

RESULTS: Five of the injuries involved children. The thumb was involved in four cases and the index finger in three. The volar plate was found to impede reduction in all cases. The operated joint was immobilised in a functional brace for a median of 3 weeks. At final follow-up (median 91 months), the metacarpophalangeal range of motion, grip power, stability and sensation were normal.

CONCLUSIONS: Using the volar surgical approach, the strangulated metacarpal head can be directly visualised and the volar plate, which is longitudinally split for reduction, can be repaired. Reduction should be performed within the first day from injury, and the joint should be immobilised in a functional position no more than 3 weeks.