Date: Mon, 10 Jun 2002 17:43:28 +0600

Subject: Thumb Dislocation

Hello All,

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.

Best regards,

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

From: ebarrick

That's an easy one. Reduce it and fuse it.

Fred Barrick

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.

Bill Obremskey

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
Melbourne Australia