Ligamentous and Capsular Injuries to the Metacarpophalangeal Joints of the Hand

The mechanism of dorsal dislocation of the metacarpophalangeal (MCP) joint is with forced hyperextension of the joint and the main structure injured is the volar plate. A simple dislocation can be reduced by closed means whereas a complex dislocation cannot. Care must be taken not to put traction across the joint, which may cause the volar plate to slip into the joint, converting a simple dislocation into a complex dislocation. Volar dislocations are rare and mainly treated nonoperatively. Sagittal band injuries can be treated with extension splinting or surgical management with direct repair or reconstruction. A locked MCP joint can usually be treated with closed manipulation. This article discusses these injuries and management options.