UMEM Educational Pearls


25 year-old female struck in the left hand by a football. Presents with pain, visible deformity, and the Xray below. What are the next step(s) in management?


Dorsal Metacarpophalangeal (MCP) Dislocation

  • MCP dislocations typically occur secondary to a hyperextension injury
  • Two categories of dislocations
    • Simple; joint spaces closely opposed and treated by closed reduction
    • Complex; volar plate is entrapped dorsal to metacarpal head with lumbricals and tendons interposed between joint surfaces; treated by operative reduction
  • To reduce a simple dislocation:
    • Provide a digital ring-block for analgesia
    • Maximally hyperextend the proximal phalanx with wrist in flexion
    • Push base of proximal phalanx distally while bending the joint into flexion
    • Test neurovascular integrity and joint-stability post-reduction by ranging the joint through a full range of motions
    • Place in thumb spica splint and refer to hand specialist


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