Date: Mon, 10 Jun 2002 17:43:28 +0600
Subject: Thumb Dislocation
A male 25 y.o. was injured in boiler explosion Apr 2, 2002 and today admitted to our unit.
Except cominuted femoral fracture he has a neglected dislocation of left thumb. What management protocol would be optimal for the pattern? Leave as is? Acute open reduction? Gradual distraction by XF, with closed or open reduction? Then XF with hinges to start ROM?
THX in advance.
Alexander N. Chelnokov
Ural Scientific Institute of Traumatology and Orthopaedics
str.Bankovsky, 7. Ekaterinburg 620014 Russia
Date: Mon, 10 Jun 2002 07:46:51 -0400
That's an easy one. Reduce it and fuse it.
Date: Mon, 10 Jun 2002 17:33:47 -0400
From: William Obremsky
How neglected is neglected? If it is 1-2 weeks, I would consider open relocation w/ a dorsal approach and pinning for 6 weeks. a stiff joint if stable w/ some motion may be better that a fusion. If grossly unstable the I would agreee w/ fusion.
Date: Tue, 11 Jun 2002 12:11:09 +1000
From: Minoo Patel
This is a palmar dislocation. The main impediments to reduction would be the dorsal structures - EPB, EPL, APL. (Patel M, Dave J. Dislocations of the metacarpophalangeal joint of the thumb. Jr Hand Surg. (Br & Eur) 22-B; 4: 499-504) The sesamoids are seen close to the proximal phalanx, which suggests that the volar plate is intact apart from being pulled off the weak accordian attachment to the metacarpal head. I would suggest a lateral approach which would allow you to go both dorsal and palmar. Reduction, debridement of the arthrofibrosis and pinning (will give a stiff but stable MCP. One might be tempted to try dynamic ex-fix with early mobilisation to get some mobility.
Minoo Patel MD FRACS
Hand and Upper Limb Surgeon
Sr Lecturer Monash University