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Joint Diseases and
Related Surgery
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Original Article · Open access

Irreducible metacarpophalangeal joint dislocations: Clinical characteristics, surgical approaches, and outcomes

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Mehmet Şah Sakçı

Department of Orthopedics and Traumatology, Batman Training and Research Hospital, Batman, Türkiye

ORCID: 0000-0003-2008-9332

Ersen Türkmen

Department of Orthopedics and Traumatology, Ezine State Hospital, Çanakkale, Türkiye

ORCID: 0000-0002-5536-6793

Mümin Karahan

Department of Orthopedics and Traumatology, Kafkas University Faculty of Medicine, Kars, Türkiye

ORCID: 0000-0002-2137-2634

Ekrem Özdemir

Department of Orthopedics and Traumatology, Erzurum City Hospital, Erzurum, Türkiye

ORCID: 0000-0002-3709-558X

Abstract

Objectives: This study aims to evaluate the clinical characteristics, surgical management, and outcomes of irreducible metacarpophalangeal (MCP) dislocations.

Patients and methods: Between August 2020 and August 2024, a total of 13 patients (7 males, 6 females; mean age: 29.2 ± 23.7 years; range, 7 to 78 years) with MCP dislocations who were surgically treated were retrospectively analyzed. Demographics, dislocation patterns, obstructing elements, operative approach, and postoperative complications were documented. Functional outcomes included MCP range of motion (ROM), extension lag, grip strength recovery compared to the contralateral hand, and patient-reported disability using the Quick Disabilities of the Arm, Shoulder and Hand questionnaire (QuickDASH) questionnaire.

Results: The index finger was most frequently involved (53.8%), with dorsal dislocations predominating (76.9%). A dorsal approach was performed in 76.9%. Dorsal reconstruction resulted in greater MCP ROM (flexion 85.8° ± 7.5° vs. 78.4° ± 6.7°), smaller extension lag (–1.8° ± 3.7° vs. –4.2° ± 5.3°), and lower disability scores (QuickDASH 4.0 ± 4.7 vs. 8.8 ± 5.5). Volar reconstruction provided superior grip strength (107.5 ± 8.7% vs. 90.9 ± 12.3%), exceeding baseline. Return-to-sport was earlier after the dorsal approach (11.5 ± 2.9 vs. 14.4 ± 3.0 weeks). Although differences did not reach statistical significance, large effect sizes (d ≥ 0.8) highlighted clinical relevance. Transient postoperative hypoesthesia occurred in two volar cases.

Conclusion: Timely operative management, tailored to dislocation type and obstructing anatomy, is essential. The dorsal approach optimizes MCP mobility, disability reduction, and athletic recovery, whereas the volar approach enhances grip strength. These complementary outcomes underscore the importance of individualized surgical selection and structured rehabilitation.

Declarations

Author Contributions

Concept and design: M.Ş.S., E.T., M.K., E.Ö.; Supervision: E.Ö.; Data collection and/or processing: E.T., M.K.; Analysis and/or interpretation: E.T., M.K., E.Ö.; Literature search: M.K., E.Ö.; Writing: M.Ş.S.; Critical review: M.Ş.S., E.T.

Conflict of Interest

The authors declared no conflicts of interest with respect to the authorship and/or publication of this article.

Financial Disclosure

The authors received no financial support for the research and/or authorship of this article.

Data Sharing Statement

The data that support the findings of this study are available from the corresponding author upon reasonable request.

AI Disclosure

The authors declare that artificial intelligence (AI) tools were not used, or were used solely for language editing, and had no role in data analysis, interpretation, or the formulation of conclusions. All scientific content, data interpretation, and conclusions are the sole responsibility of the authors. The authors further confirm that AI tools were not used to generate, fabricate, or ‘hallucinate’ references, and that all references have been carefully verified for accuracy.

References

  1. Kono H, Saito M, Sato N, Ochiai S, Ichikawa J, Wako M, et al. Chronic dislocations of the fourth and fifth carpometacarpal joints with successful treatment by ligament repair: A case report and literature review. Jt Dis Relat Surg 2024;35:699-705. DOI: 10.52312/jdrs.2024.1724.
  2. Kabbani KT, Dimos K, Kosmas D, Kampani N, Papathanasiou G, Tsiomita E, et al. Volar metacarpophalangeal dislocation of fingers: Review of the literature. J Hand Surg Glob Online 2021;3:228-32. DOI: 10.1016/j.jhsg.2021.04.001.
  3. Sattari SA, Sattari AR, Heydari K, Sadat Kiaei SM, Zandrahimi F, Mohammadpour M. Dorsal approach in the surgical treatment of complex dorsal dislocation of index metacarpophalangeal joint; A case report. Arch Acad Emerg Med 2022;10:e13. DOI: 10.22037/aaem.v10i1.1479.
  4. O'Neill ES, Qin MM, Chen KJ, Hansdorfer MA, Doscher ME. Dislocation of the metacarpophalangeal joint of the index finger requiring open reduction due to the presence of an intra-articular sesamoid bone. SAGE Open Med Case Rep 2021;9:2050313X211021180. DOI: 10.1177/2050313X211021180.
  5. Srivastava S, Afaque SF. Complex metacarpophalangeal joint dislocation of the index finger in pediatric age: A case report and review of literature. J Orthop Case Rep 2022;12:102-5. DOI: 10.13107/jocr.2022.v12.i08.2984.
  6. Bouya A, Bennis A, Zaddoug O, Benchakroun M, Zine A, Bouabid S. Complex dorsal metacarpophalangeal joint dislocation associated with proximal metacarpal fracture: Case report and review of the literature. Int J Surg Case Rep 2024;118:109532. DOI: 10.1016/j.ijscr.2024.109532.
  7. Temporin K, Miyamura S, Oura K, Shimada K. Chronic volar dislocation of the metacarpophalangeal joint of the thumb treated with open reduction: A case report and literature review. J Orthop Sci 2023;28:1525-8. DOI: 10.1016/j.jos.2021.08.022.
  8. Yigit Ş, Gürcan S. Neglected volar subluxation of the metacarpophalangeal joint of the thumb: A case report. Acta Biomed 2021;92:e2021034. DOI: 10.23750/abm.v92iS1.9183.
  9. Dinh P, Franklin A, Hutchinson B, Schnall SB, Fassola I. Metacarpophalangeal joint dislocation. J Am Acad Orthop Surg 2009;17:318-24. DOI: 10.5435/00124635-200905000-00006.
  10. Tanrıverdi B, Çiftçi MU. The floating first metacarpal: A rare case. Jt Dis Relat Surg 2023;34:474-9. DOI: 10.52312/jdrs.2023.922.
  11. Vadala CJ, Ward CM. Dorsal approach decreases operative time for complex metacarpophalangeal dislocations. J Hand Surg Am 2016;41:e259-62. DOI: 10.1016/j.jhsa.2016.05.020.
  12. Wang WH, Hou CL, Tan XY, Wang Y. Early open reduction of acute incarceratied metacarpophalangeal dislocation. Zhongguo Gu Shang 2008;21:293-4.
  13. Yüksel S, Adanır O, Beytemur O, Gülec MA. Volar dislocation of the metacarpophalangeal joint of the thumb: A case report. Acta Orthop Traumatol Turc 2017;51:352-4. DOI: 10.1016/j.aott.2017.03.014.
  14. Rubin G, Orbach H, Rinott M, Rozen N. Complex dorsal metacarpophalangeal dislocation: Long-term follow-up. J Hand Surg Am 2016;41:e229-33. DOI: 10.1016/j.jhsa.2016.05.010.
  15. Panagiotopoulos V, Konstantinidis C, Plakoutsis S, Kotsias C, Vardakas D, Giotis D. Management of a rare case of complex and irreducible dislocation of the metacarpophalangeal joint in the little finger - A case report. J Orthop Case Rep 2025;15:14-8. DOI: 10.13107/jocr.2025.v15.i06.5646.
  16. Daoulas T, Ducournau F, Agneray H, Ardouin L, Gaisne E, Bellemère P. Treatment of long finger metacarpophalangeal arthritis using HAPY® pyrocarbon interposition implants: A study of 34 cases. Hand Surg Rehabil 2025;44:102068. DOI: 10.1016/j.hansur.2024.102068.
  17. De Jonge MC, Assink J, Vanhoenacker FM. Acute bony injuries of hand and wrist. Semin Musculoskelet Radiol 2021;25:277-93. DOI: 10.1055/s-0041-1729151.
  18. George S, Rizkallah M, Leviet D, Leclercq C, El Abiad R. Early vs late surgical treatment of radial instability of the thumb metacarpophalangeal joint. A retrospective cohort study. Hand Surg Rehabil 2021;40:771-6. DOI: 10.1016/j.hansur.2021.08.008.
  19. Balachandran A, Sinha S. Closed reduction of multiple MCP joint dislocations. BMJ Case Rep 2025;18:e264340. DOI: 10.1136/bcr-2024-264340.
  20. Pereira JM, Quesado M, Silva M, Carvalho JDD, Nogueira H, Alves J. The lateral approach in the surgical treatment of a complex dorsal metacarpophalangeal joint dislocation of the index finger. Case Rep Orthop 2019;2019:1063829. DOI: 10.1155/2019/1063829.
  21. Boubcheur M, Rhoul A, Bensalah S, Yacoubi H. Complex dorsal dislocation of the metacarpophalangeal joint of the fifth finger treated by open reduction with volar approach: A case report. Cureus 2025;17:e84603. DOI: 10.7759/cureus.84603.
  22. Yadav SK, Nayak B, Mittal S. New approach to second metacarpophalangeal joint dislocation management: The SKY needling technique. Eur J Orthop Surg Traumatol 2021;31:189-92. DOI: 10.1007/s00590-020-02728-w.
  23. Vrindten K, O'Leary CJ, Lee H, Amancharla N, Kirschenbaum D, Katt BM. Management of non-thumb volar metacarpophalangeal joint dislocations: Case series and review of literature. Hand (N Y) 2025:15589447251339499. DOI: 10.1177/15589447251339499.
  24. Żyluk A. Results of the treatment of carpo-metacarpal joints dislocations. Ortop Traumatol Rehabil 2024;26:203-11. DOI: 10.5604/01.3001.0054.9876.
  25. Lee S, Jeon SH. Locking of the metacarpophalangeal joint of the thumb caused by entrapment of the radial sesamoid bone. J Hand Surg Asian Pac Vol 2022;27:580-5. DOI: 10.1142/S2424835522720274.
  26. Minami A, Katoh S, Minami M. Palmar luxation of the metacarpophalangeal joint. Report of a case and review of the literature. Rev Chir Orthop Reparatrice Appar Mot 1989;75:53-5.
  27. Beutel BG, Wang J, Taqi M. Finger Dislocation. 2025 Jun 2. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025.
  28. Dukan R, Pichard R, Ng ZY, Shekouhi R, Chim H. Combined distal interphalangeal joint arthrodesis with proximal ınterphalangeal joint arthroplasty or arthrodesis: Technical considerations. J Hand Surg Am 2025;50:223-9. DOI: 10.1016/j.jhsa.2024.08.006.