Patluri Rohit Raj, Gummadi Akhila
Department of Orthopaedics, Viswabharathi Medical College, Kurnool, Andhra Pradesh, India.
J Orthop Case Rep. 2022 Oct;12(10):70-73. doi: 10.13107/jocr.2022.v12.i10.3372.
In most cases, the volar plate interposition renders the complex metacarpophalangeal joint dislocation, commonly known as Kaplan's lesion, intractable, necessitating open reduction. The capsuloligamentous attachments around the joint and the head of the metacarpal are buttonholed in this dislocation, limiting closed reduction.
It is presented here a case of 42-year-old male with the left Kaplan's lesion with open wound. The dorsal technique would have decreased neurovascular compromise and prevented the reduction otherwise by exposing the fibrocartilagenous volar plate directly; however, in this case, the volar route was adopted since an open wound exposed the metacarpal head volarly rather than dorsally. After repositioning the volar plate, a metacarpal head splint was applied and physiotherapy was started a few weeks later.
Volar technique has been confidently employed because the wound was not related to a fracture and the open wound through which the incision was extended was already existing, allowing for easy access to the lesion and leading to positive outcomes, such as better range of motion postoperatively.
在大多数情况下，掌板嵌入会使常见的复杂掌指关节脱位（即所谓的卡普兰损伤）变得难以处理，需要进行切开复位。在这种脱位中，关节周围和掌骨头的关节囊韧带附着处会出现纽扣孔样改变，限制了闭合复位。
本文介绍了一名42岁男性左卡普兰损伤伴开放性伤口的病例。背侧技术本可减少神经血管损伤，并通过直接暴露掌侧纤维软骨掌板来避免复位失败；然而，在该病例中，由于开放性伤口使掌骨头暴露在掌侧而非背侧，因此采用了掌侧入路。复位掌板后，应用了掌骨头夹板，并在几周后开始进行物理治疗。
采用掌侧技术是因为伤口与骨折无关，且用于延长切口的开放性伤口已经存在，便于接近损伤部位并取得了积极的效果，如术后更好的活动范围。
