2nd Metacarpophalangeal joint fracture dislocation [Kaplan’s Lesion] operated by open reduction with dorsal approach: A case report

Abstract

Kaplan’s injury is the dislocations of metacarpophalangeal (MCP) joint dorsally. It may be seen in all five fingers but usually index finger is more prone to such injury. In Kaplan dislocation the head of the metacarpal button-holed through the constraint soft tissue surroundings and the volar plate goes dorsal to the metacarpal head which makes it irreducible by closed method. Both dorsal & volar approaches have been described in many literature for open reduction for the dislocation. Though, the right approach to treat such lesions is still a debate, it is the volar approach which is widely used & described more in literature. Some prefer dorsal approach. Volar approach is very prone to iatrogenic neurovascular injure.Surgical Procedure: Dorsal approach was used. This volar plate was completely dorsally dislocated. Head of metacarpal found fractured. A longitudinal incision was made over the plate & the head of the metacarpal was gently elevated & allowed to relocate. K wire was inserted through fracture fragment into the metacarpal head.Result: As follow-up after 6 weeks, the patient’s active range of motion consisted of metacarpophalyngeal joint hyperextension to 10° and 75° of flexion, proximal interphalangeal joint extension to 0° and flexion to 70°, and distal interphalangeal joint extension to 0° and flexion to 60°. Neurovascular evaluation was within normal limits. X-rays confirmed maintenance of reduction.