II. Definition
- Dislocation at MCP
- MCP Dislocation is most often at thumb
- Dorsal MCP Dislocation is most common
III. Types of Metacarpal-phalangeal (MCP) Dislocation
- Simple Dislocation
- Dislocation without interposed soft tissue
- Complex Dislocation
- Soft tissue interposed in the joint
- Requires surgical reduction
IV. Management: Simple Dislocation
- Reduction (dorsal dislocation)
- Flex wrist
- Hyperextend dislocated joint as far as possible
- Push base of proximal phalanx distally
- Bring joint back into flexion while pushing base
- Avoid simple traction (risk of complex dislocation)
- Post-reduction joint assessment
- Assess joint range of motion
- Assess collateral ligaments with MCP flexed
- Imaging to assess joint congruity
- Immobilization for 3 weeks
- Early range of motion and strengthening in uncomplicated dislocations
- Direction of dislocation
- Dorsal dislocation: Splint 20-30 degrees of flexion
- Volar dislocation: Splint to maintain extension
- Discuss with local orthopedic consultants
- Finger involved
- Thumb MCP Dislocation: Cast thumb for 3 weeks
- Finger MCP Dislocation: Buddy tape for 3 weeks
V. Management: Complex Dislocation
- Reduction usually impossible by closed method
- Joint does not snap back into place
- Joint does not feel reduced
- Reduction prevented by soft tissue in joint
- Surgery usually needed
- Open reduction and internal fixation (ORIF)
