Volar Dislocation of Second Metacarpophalangeal Joint-open Reduction with Volar Approach - A rare Case Report.

Abstract

In most cases, the volar plate interposition renders the complex metacarpophalangeal joint dislocation, commonly known as Kaplan's lesion, intractable, necessitating open reduction. The capsuloligamentous attachments around the joint and the head of the metacarpal are buttonholed in this dislocation, limiting closed reduction. It is presented here a case of 42-year-old male with the left Kaplan's lesion with open wound. The dorsal technique would have decreased neurovascular compromise and prevented the reduction otherwise by exposing the fibrocartilagenous volar plate directly; however, in this case, the volar route was adopted since an open wound exposed the metacarpal head volarly rather than dorsally. After repositioning the volar plate, a metacarpal head splint was applied and physiotherapy was started a few weeks later. Volar technique has been confidently employed because the wound was not related to a fracture and the open wound through which the incision was extended was already existing, allowing for easy access to the lesion and leading to positive outcomes, such as better range of motion postoperatively.