Kaplan's Lesion – Functional and Radiological Outcome of Open Reduction by Dorsal Approach: A Case Series.
DOI:
https://doi.org/10.51168/fhwhv898Cuvinte cheie:
Kaplan's lesion, Metacarpophalangeal joint dislocation, Dorsal approach, Open reduction, Volar plate, K-wire fixationRezumat
Background:
Kaplan's lesion is an uncommon complex dorsal dislocation of the metacarpophalangeal (MCP) joint caused by forceful hyperextension, with interposition of the volar plate and surrounding soft tissues. Closed reduction frequently fails, requiring open reduction. This case series describes the clinical, functional, and radiological outcomes following dorsal open reduction.
Case Presentation:
Five adult male patients with complex dorsal dislocation of the index MCP joint were treated at PRM Medical College and Hospital, Baripada, Odisha, between January 2022 and August 2023, with a minimum follow-up of one year. All injuries resulted from road traffic accidents, and closed reduction failed in all cases. Three patients underwent mobilization of the volar plate using a thin osteotome, while two delayed cases required longitudinal splitting of the volar plate. Stable reduction was achieved in all patients, with K-wire fixation as required. One patient with an associated osteochondral fragment underwent fixation with two K-wires.
Conclusion:
At one-year follow-up, all patients maintained anatomical reduction and joint congruity. Mean VAS pain score decreased from 8.6 to 0.4, while mean MCP flexion improved from 0° to 82°. All patients returned to their pre-injury occupations within three months, with no redislocation, infection, neurovascular injury, or revision surgery.
Take-away Lessons:
When closed reduction fails, early recognition and open reduction of Kaplan's lesion are important. The dorsal approach allows direct management of the entrapped volar plate and can provide stable reduction and satisfactory functional recovery.
Referințe
1. Mahajan NP, Patil TC, Sangma S. Management of complex Kaplan's dislocation by open dorsal approach: a case report. J Orthop Case Rep. 2021;11(11):84-87.
2. Kaplan EB. Dorsal dislocation of the metacarpophalangeal joint of the index finger. J Bone Joint Surg Am. 1957;39-A:1081-1086. https://doi.org/10.2106/00004623-195739050-00008
3. Um JH, Kim SH, Jo DI. Kaplan's lesion of the little finger treated with open reduction by a volar approach: a case report. J Wound Manag Res. 2021;17(2):120-124. https://doi.org/10.22467/jwmr.2021.01578
4. Patterson RW, Maschke SD, Evans PJ, Lawton JN. Dorsal approach for open reduction of complex metacarpophalangeal joint dislocations. Orthopedics. 2008;31(11):1099.
https://doi.org/10.3928/01477447-20081101-22
5. Sreeranga, Lakshmeesha T, Kumar S, Kumar V. Kaplan's lesion treated with open reduction by dorsal approach. Indian J Orthop Surg. 2015;1(4):273-278.
https://doi.org/10.5958/2395-1362.2015.00041.9
6. Dinh P, Franklin A, Hutchinson B, Schnall SB, Fassler PR. Metacarpophalangeal joint dislocation. J Am Acad Orthop Surg. 2009;17(5):318-324.
https://doi.org/10.5435/00124635-200905000-00006
7. May JW Jr, Rohrich RJ, Sheppard J. Closed complex dorsal dislocation of the middle finger metacarpophalangeal joint: anatomic considerations and treatment. Plast Reconstr Surg. 1988;82(4):690-693. https://doi.org/10.1097/00006534-198810000-00024
8. Barry K, McGee H, Curtin J. Complex dislocation of the metacarpophalangeal joint of the index finger: a comparison of the surgical approaches. J Hand Surg Br. 1988;13(4):466-468. https://doi.org/10.1016/0266-7681_88_90182-9
9. Meurer WJ, Kronick SL, Lowell MJ, Desmond JS, Mudgal CS. Complex metacarpophalangeal dislocation. Int J Emerg Med. 2008;1(3):227-230. https://doi.org/10.1007/s12245-008-0058-7
10. Durakbasa O, Guneri B. The volar surgical approach in complex dorsal metacarpophalangeal dislocations. Injury. 2009;40(6):657-659.
https://doi.org/10.1016/j.injury.2008.10.027
11. Becton JL, Christian JD Jr, Goodwin HN, Jackson JG III. A simplified technique for treating the complex dislocation of the index metacarpophalangeal joint. J Bone Joint Surg Am. 1975;57(5):698-700. https://doi.org/10.2106/00004623-197557050-00024
12. Thakur AK, Pradhan NM, Devkota P, Gyawali B, Pokhrel PM. Kaplan's lesion in a child: a case report. J Nepal Med Assoc. 2022;60(255):975-977. https://doi.org/10.31729/jnma.7901
13. Sattari SA, Sattari AR, Heydari K, Kiaei SMS, Zandrahimi F, Mohammadpour M. Dorsal approach in the surgical treatment of complex dorsal dislocation of index metacarpophalangeal joint: a case report. Arch Acad Emerg Med. 2022;10(1):e13.
14. Chitnis SS, Chitnis SL. Indication for CT following index finger metacarpophalangeal joint dislocation: a case report. Trauma Case Rep. 2018;18:31-36.
https://doi.org/10.1016/j.tcr.2018.11.014
15. Durand Y, Rodriguez NN, Georgopoulos S, Mesoraca C, Jaën M. Complex metacarpophalangeal joint dislocation (Kaplan's lesion) of the index finger in a 5-year-old patient: a case report. J Orthop Case Rep. 2024;14(1):141-145.
Descărcări
Publicat
Număr
Secțiune
Licență
Copyright (c) 2026 Rashmi Ranjan Dash, Indrajit Munda, Barada Prasanna Samal, Subhamaya Chinmaya Swain
TAceastă lucrare este licențiată în temeiul Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
