Complex Dorsal Dislocation of the Metacarpophalangeal Joint of the Fifth Finger Treated by Open Reduction With Volar Approach: A Case Report

Complex dorsal dislocations of the metacarpophalangeal (MCP) joint are rare, with involvement of the fifth finger being exceedingly uncommon. These injuries typically result from hyperextension forces that entrap the volar plate, precluding successful closed reduction and necessitating surgical intervention. In this report, we present the case of a 20-year-old male patient who sustained multiple injuries, including craniofacial trauma and an open dorsal dislocation of the left fifth MCP joint, following a road traffic accident. Initial attempts at closed reduction under local anesthesia were unsuccessful, prompting surgical consultation. The patient underwent open reduction via a volar approach, which involved a vertical incision adjacent to the metacarpal head. Intraoperative findings revealed a ruptured volar plate with an attached sesamoid bone, as well as displaced soft tissue structures, including the natatory and superficial transverse ligaments. Gentle retraction and manipulation using a Freer elevator facilitated the reduction of the proximal phalanx and allowed for reconstruction of the volar plate. Postoperative management included brief splinting followed by hand rehabilitation. Radiographic evaluation confirmed maintained reduction without re-dislocation, and the patient ultimately regained nearly full range of motion with no long-term functional deficits or pain. This case highlights the challenges in managing complex MCP dislocations and underscores the importance of prompt surgical intervention. A review of the current literature is provided, discussing the merits and drawbacks of various open reduction techniques, with an emphasis on the volar approach as a reliable option for achieving favorable outcomes in such rare injuries.