Irreducible metacarpophalangeal joint dislocations: Clinical characteristics, surgical approaches, and outcomes

This study aims to evaluate the clinical characteristics, surgical management, and outcomes of irreducible metacarpophalangeal (MCP) dislocations.

Between August 2020 and August 2024, a total of 13 patients (7 males, 6 females; mean age: 29.2 ± 23.7 years; range, 7 to 78 years) with MCP dislocations who were surgically treated were retrospectively analyzed. Demographics, dislocation patterns, obstructing elements, operative approach, and postoperative complications were documented. Functional outcomes included MCP range of motion (ROM), extension lag, grip strength recovery compared to the contralateral hand, and patient-reported disability using the Quick Disabilities of the Arm, Shoulder and Hand questionnaire (QuickDASH) questionnaire.

The index finger was most frequently involved (53.8%), with dorsal dislocations predominating (76.9%). A dorsal approach was performed in 76.9%. Dorsal reconstruction resulted in greater MCP ROM (flexion 85.8° ± 7.5° vs. 78.4° ± 6.7°), smaller extension lag (-1.8° ± 3.7° vs. -4.2° ± 5.3°), and lower disability scores (QuickDASH 4.0 ± 4.7 vs. 8.8 ± 5.5). Volar reconstruction provided superior grip strength (107.5 ± 8.7% vs. 90.9 ± 12.3%), exceeding baseline. Return-to-sport was earlier after the dorsal approach (11.5 ± 2.9 vs. 14.4 ± 3.0 weeks). Although differences did not reach statistical significance, large effect sizes (d ≥ 0.8) highlighted clinical relevance. Transient postoperative hypoesthesia occurred in two volar cases.

Timely operative management, tailored to dislocation type and obstructing anatomy, is essential. The dorsal approach optimizes MCP mobility, disability reduction, and athletic recovery, whereas the volar approach enhances grip strength. These complementary outcomes underscore the importance of individualized surgical selection and structured rehabilitation.