Dorsal Approach for Dorsal Complex Metacarpophalangeal Dislocation of the Index Finger 1. MS Ortho; DNB Ortho; MNAMS, Associate Professor, Orthopedics, Padmashri Dr D.Y.Patil Medical College, Pimpri, Pune, 411018. 2. MS Ortho, DNB Ortho, MNAMS; MRCS Eng; FICS (USA), Associate Professor, Orthopedics, Padmashri Dr D.Y.Patil Medical College, Pimpri, Pune, 411018. * Correspondence should be addressed to: Ajit Swamy C- 7, Sukhwani Park, Vastu Udyog, Pimpri, Pune, 411018, Maharashtra, India. E- Mail: ajit.swamy@yahoo.co.in © 2012 DAR Publishers/ University of Jordan. All Rights Reserved. Ajit Swamy, 1* Amit Swamy 2 Abstract Dorsal complex dislocations of metacarpophalangeal joints are a rare injury. Various anatomical structures have been blamed to preclude closed reduction and controversy also exists regarding the ideal approach. We reviewed 5 patients whom we treated with open reduction via the dorsal approach, and we had consistently good results. Keywords: Complex dorsal, metacarpophalangeal dislocation, open reduction, dorsal approach. (J Med J 2012; Vol. 46 (4):347- 350) Received Accepted December 15, 2011 March 25, 2012 Introduction Complex dorsal dislocation of the metacarpophalangeal joint is a rare injury. 1 It is important to differentiate this injury from simple subluxation, 2 which can be reduced by closed means. 3 The index finger is most commonly involved. 1 Farabeuf 4 coined the term complex dislocation and Kaplan 5 published his article describing the anatomical factors preventing reduction. Various structures have been implicated, but all agree that the most important and consistent element preventing reduction is volar plate interposition which breaks away from its proximal attachment to the metacarpal neck and comes to lie within the joint space. This requires surgical extraction. Methods Five patients who presented with complex dorsal dislocation were evaluated. All suffered hyperextension injuries to the index metacarpophalangeal joint. Four were male and one female. Three were involved in road traffic accidents and one of the patients also had a concomitant forearm fracture. There was no neurovascular deficit. Classical clinical and radiological hallmarks described by Rockwood were present. 1 The index finger was held only slightly hyperextended with puckering of the palmar skin with the radiological hallmark of sesamoid within a widened joint space.