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Metacarpophalageal Joint Dislocation S63.116A 834.01

 

ICD-9 Classification / Treatment
Etiology / Natural History Associated Injuries / DDx
Anatomy Complications
Clinical Evaluation Follow-up Care
Xray / Diagnositc Tests Review References

synonyms:MCP dislocation

Metacarpophalageal Joint Dislocation ICD-10

 

A- initial encounter

D- subsequent encounter

S- sequela

Metacarpophalageal Joint Dislocation ICD-9

  • 834.01  closed dislocation Metacarpophalageal Joint
  • 834.11  open dislocation Metacarpophalageal Joint

Metacarpophalageal Joint Dislocation Etiology / Epidemiology / Natural History

  • Generally caused by a fall on the outstretched hand causing forcible hyperextension of the MCP joint. Volar dislocations may result from hyperflexion injury. 
  • Dorsal dislocations >> volar dislocations5
  • Index finger is most frequently involved, followed by the thumb.
  • The volar plate is avulsed from its metacarpal neck attachment during dorsal dislocation and may become interposed within the joint preventing reduction. Other structures may also prevent reduction: lumbrical muscle,  flexor tendons,  natatory ligament, superficial transverse metacarpal ligament.
  • Volar dislocations may be irreducible due to: dorsal capsule, distal insertion of the volar plate, collateral ligament,  tendinous juncture connecting the fourth and fifth extensor digitorum communis tendons, dorsal
    interosseous muscle, sesamoid bone.

Metacarpophalageal Joint Dislocation Anatomy

  • Proper collateral ligaments are the primary stabilizers of the MCP joint: taut in flexion, lax in extension.
  • Accessory collateral ligaments originate volar to the proper collateral ligaments and insert onto
    the volar plate;  taut in extension and lax in flexion.
  • Volar plate: thick fibrocartilaginous portion distally and a looser, membranous portion proximally.

Metacarpophalageal Joint Dislocation Clinical Evaluation

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Metacarpophalageal Joint Dislocation Xray / Diagnositc Tests

  •  A/P, lateral and oblique xrays of the hand demonstrate dislocation to the MCP joint. 

Metacarpophalageal Joint Dislocation Classification / Treatment

  • Complex dislocation:  proximal phalanx nearly parallel with the metacarpal.  Palmar plate, is entrapped in the MP joint.  Requires open reduction.  The palmar plate is incised longitudinally through its midline, allowing the metacarpal head to be reduced.
  • Simple dorsal dislocation: proximal phalanx is nearly perpendicular to the joint.  Reduction: wrist is flexed to allow relaxation of the flexor tendons.  Distal traction as well as volar-directed pressure to the base of the proximal phalanx generally provides reduction of a simple dislocation. 
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Metacarpophalageal Joint Dislocation Associated Injuries / Differential Diagnosis

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Metacarpophalageal Joint Dislocation Complications

  • Stiffness

Metacarpophalageal Joint Dislocation Follow-up Care

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Metacarpophalageal Joint Dislocation Review References

  • Dinh P,  JAAOS; 2009 ; 17:318
  • Becton JL, Christian JD Jr, Goodwin HN, Jackson JG 3rd. A simplified technique for treating the complex dislocation of the index metacarpophalangeal joint. J Bone Joint Surg Am. 1975 Jul;57(5):698-700.  
  • Green DP, Terry GC. Complex dislocation of the metacarpophalangeal joint. Correlative pathological anatomy. J Bone Joint Surg Am. 1973 Oct;55(7):1480-6.


 

 

 

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