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Does Irreducibility Always Mean A Complex Dislocation? An Analysis of 33 Pediatric Metacarpophalangeal Joint Dislocations.

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Citation: Plastic & Reconstructive Surgery. 2023 Mar 22PMID: 36946903Institution: Curtis National Hand CenterForm of publication: Journal ArticleMedline article type(s): Journal ArticleSubject headings: IN PROCESS -- NOT YET INDEXEDYear: 2023 ISSN:

0032-1052

Name of journal: Plastic and reconstructive surgeryAbstract: BACKGROUND: Historically, prior failed reduction and certain radiographic indicators have been used to differentiate simple and complex metacarpophalangeal joint (MPJ) dislocations in children, the latter of which warrants open reduction. This investigation aimed to determine the necessity for open reduction with these indicators and establish a new treatment algorithm and educational focus for these rare injuries.CONCLUSIONS: This study supports closed reduction of pediatric MPJ dislocations in the OR under general anesthesia before converting to open reduction regardless of injury characteristics or prior reduction attempts. This strategy is likely to limit unnecessary open surgery and related risks. Copyright © 2023 by the American Society of Plastic Surgeons.METHODS: A 12-year retrospective study was conducted on all children with MPJ dislocations at a single pediatric hospital. The rate of successful closed reduction, number of reduction attempts, and radiographic findings were detailed. Operative details and post-operative outcomes were also gathered.RESULTS: Thirty-three patients were included with a mean age of 11.1 years old. Most were male (n=27,82%) and underwent 2 or more prior reduction attempts at an outside facility. Stable closed reduction was then achieved outside of the operating room in 5 patients and in the OR under general anesthesia in another 14, for a total of 19/33 patients (57.6%). The thumb was most often injured (n=19,57.6%) and more likely to undergo successful closed reduction (p=0.04). There was no relationship between number of prior reduction attempts and ability to achieve closed reduction (p=0.72). Radiographically, neither joint space widening nor proximal phalanx bayonetting correlated with failure of closed reduction (p=0.22 and p=1, respectively).All authors: Bauder AR, Graham EM, Shubinets V, Mendenhall SD, Carrigan RB, Lin IC, Shah A, Chang BFiscal year: FY2023 Digital Object Identifier:

https://dx.doi.org/10.1097/PRS.0000000000010455

Date added to catalog: 2023-04-11

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BACKGROUND: Historically, prior failed reduction and certain radiographic indicators have been used to differentiate simple and complex metacarpophalangeal joint (MPJ) dislocations in children, the latter of which warrants open reduction. This investigation aimed to determine the necessity for open reduction with these indicators and establish a new treatment algorithm and educational focus for these rare injuries.

CONCLUSIONS: This study supports closed reduction of pediatric MPJ dislocations in the OR under general anesthesia before converting to open reduction regardless of injury characteristics or prior reduction attempts. This strategy is likely to limit unnecessary open surgery and related risks. Copyright © 2023 by the American Society of Plastic Surgeons.

METHODS: A 12-year retrospective study was conducted on all children with MPJ dislocations at a single pediatric hospital. The rate of successful closed reduction, number of reduction attempts, and radiographic findings were detailed. Operative details and post-operative outcomes were also gathered.

RESULTS: Thirty-three patients were included with a mean age of 11.1 years old. Most were male (n=27,82%) and underwent 2 or more prior reduction attempts at an outside facility. Stable closed reduction was then achieved outside of the operating room in 5 patients and in the OR under general anesthesia in another 14, for a total of 19/33 patients (57.6%). The thumb was most often injured (n=19,57.6%) and more likely to undergo successful closed reduction (p=0.04). There was no relationship between number of prior reduction attempts and ability to achieve closed reduction (p=0.72). Radiographically, neither joint space widening nor proximal phalanx bayonetting correlated with failure of closed reduction (p=0.22 and p=1, respectively).

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