Isolated dorsal approach for the treatment of neglected volar metacarpophalangeal joint dislocations

Figure 1 Preoperative and postoperative clinical radiological images of case 1. A: Pre-operative 30° limitation of flexion in the 4^th and 60° limitation of flexion in the 5^th metacarpophalangeal (MP) joint; B: Preoperative AP and lateral radiographies; C: 4^th MP joint has 20° and 5^th MP joint has 30° limitation of flexion at 2 mo postoperative; D: Full flexion at the 4^th MP joint and 10 degrees limitation of flexion at the 5^th MP joint at postoperative 12^th month; E: Radiographies at 12^th month. The reduction is maintained and the osteotomy line at the 4^th proximal phalanx had fused.

Figure 2 Preoperative and postoperative clinical radiological images of case 2. A: Preoperative 70 degrees of limitation of flexion at the 4^th metacarpophalangeal joint. There is a deformity dorsal to the proximal phalanx proximal joint surface; B: 30 degrees of limitation of flexion and union of the proximal phalangeal osteotomy line at 8^th month control.

Figure 3 Exposure of the dislocated metacarpophalangeal joint with a dorsal approach. Because of the deformation of the dorsal joint surface of the 4^th proximal phalanx, a volar closing wedge osteotomy was done, which was then stabilized with a K wire.

Figure 4 Full flexion at the 4^th metacarpophalangeal joint and 10 degrees limitation of flexion at the 5^th metacarpophalangeal joint at postoperative 12^th month. The 4^th and 5^th metacarpophalangeal joints have full extension.