Vulnerability of the radial digital neurovascular bundle of the index finger while using the Kaplan’s volar approach for irreducible dislocation of the second metacarpophalangeal joint

Abstract

Irreducible dislocations of the second metacarpophalangeal joints can be surgically reduced using the Kaplan’s volar approach or the dorsal approach. We report on our experience of reducing these dislocations by the Kaplans volar approach in nine patients. This approach was preferred since the visualisation of the offending volar fibrocartilagenous plate is best with the use of this approach. In majority of the cases (six out of nine), we found that the radial neurovascular bundle was displaced to lie directly over the head of the metacarpal. The aim of this paper is to highlight the fact that the digital neurovascular bundle to the radial side of the index finger is displaced over the head of the metacarpal in a large number of patients and any transverse volar incision has to be made very carefully since this neurovascular bundle lies just under the skin which is puckered and with almost negligible subcutaneous tissue. If the operating surgeon is not careful enough, then it may lead to iatrogenic injury to the digital neurovascular bundle with associated morbidity.