Tuesday, November 5, 2002
963

Management of Chronic Metacapalphalangeal Joint Dislocations in Pediatric Patients

David C. Kim, MD, Gary F. Wingate, MD, Paul S. Kim, MD, and Donald Mazur, MD.

Title: Management of Chronic Metacarpalphalangeal Joint Dislocations in Pediatric Patients Introduction: Dorsal dislocation of the metacarpalphalangeal (mcp) joint is an uncommon entity. With few exceptions the deformity is caused by a single traumatic hyperextension injury to the joint. Typically, the injury presents in adults and most commonly affects the thumb. We present the surgical management of chronic, isolated dorsal mcp dislocations of the small finger in three pediatric patients. In each of the patients the deformity was from a distinct cause. Materials & Method Three pediatric patients presented with dorsal mcp dislocations of the small finger. All three patients were female and their ages 14,10,16 years. The dominant hand was involved in 2 cases, and the duration of deformity prior to presentation was several years, three months, and one month respectfully. In one patient the deformity was the result of an aberrant sesamoid bone, the other an aberrant lumbrical muscle, and the last from trauma. Each of the patients were surgically explored and their deformity corrected by performing a volar plate arthroplasty. The proximal portion of the volar plate was imbricated to the periosteum using nonabsorbable sutures. A fixating pin was then placed across the joint in 60º flexion for two weeks. The digit was immobilized in a hand based, dorsal block splint for an additional two weeks and therapy begun. Four weeks post-op gentle active range of motion was initiated. At six weeks post-op the dorsal block splint was gradually weaned to neutral position.Gentle strenghtening began eight weeks post-op and buddy straps applied Results In all three patients, the mcp dislocation was corrected. There were no perioperative complications. Full range of motion and preoperative grip strength was achieved in each patient, with no residual joint hyperextension or joint instability. Discussion The literature is sparse on the operative management of chronic mcp dislocations in pediatric patients. Most reports involve adults with acute deformities. Similarly, cases involving pediatric patients are also the result of acute, single traumatic events. We present three pediatric patients, each with a different cause of chronic mcp deformity. In each of these cases a volar plate arthroplasty was successfully performed. Conclusion Volar plate arthroplasty of the metacarpalphalangeal joint is a safe and reliable method of correcting this unusual hand deformity in the pediatric patient.
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