Clinical Case 084: Difficult dislocation April 15, 2013 OK Here is a quick case. One that is a bit outside the norm – not your usual dislocation. In this case a 14 yo boy presents after falling on the football field. He landed awkwardly on his hand “popping” his index finger at the knuckle. On arrival he has an obviously swollen, deformed MCP on the 2nd digit. A quick X-ray looks like this (click to make the picture bigger!): Q1: What is the diagnosis? Who is it named after? Q2: After a quick local block – you pull on the finger – but it aint budging. Why? Q3: What is the most oft described strategy for managing this injury? TwitterFacebookLinkedInEmailRedditPocket Tags:diagnosis, dislocation, orthopaedics Related Posts First10EM Journal Club: August 2020 Clinical Case 017: Dr Sally’s Unusual Ulcers A Bridge over Troubled waters? About The Author Casey Parker I am a GP working in Broome, NW of Western Australia. I work as a hospital DMO (District Med Officer) doing Emergency, Anaesthestics, some Obstetrics and a lot of miscellaneous primary care. Also on the web as @broomedocs | + Casey Parker | Contact 4 Comments Hildy I’ve never heard of an eponymous name for these. However, these are often impossible to reduce closed, because the metacarpal head can buttonhole between the flexor tendons, or the volar plate can interpose itself into the joint. Usually these are treated with open reduction without internal (metalwork) fixation; in a young child like this a couple of stitches into the volar plate and a POSI splint for 4-6 weeks followed by a period of buddy splinting should do the trick. April 16, 2013 Reply Gerry If it aint going back in then its probably button-holed. i.e. flexor tendon involvement. Guessing named after ?Boutonierrie (French fails me). I always thought had to go for surgery, but keen to hear any tips/tricks! April 16, 2013 Reply Hildy Something which is terrifying is that an injury as innocuous-seeming as this would, a hundred years ago, have crippled this boy for life. (presumably right-hand dominant, and the quadriga phenomenon would mean that he had markedly lessened grip strength in the other fingers of the hand). Crazy question: if you could not operate on this boy (imagine you’re in deepest Africa, and a young hunter has just sustained a hunting injury) what would your management be to maximise his long term outcome? April 16, 2013 Reply Jordan Webb Pretty sure Kaplan first described complex MCPJ dislocations. I think the lumbricals get involved in the entrapment also. April 16, 2013 Reply Add a Comment Cancel replyYour email address will not be published. Required fields are marked *Comment Notify me of follow-up comments by email. Notify me of new posts by email.