Preserved Thumb Function After First MCP Joint Arthrodesis with Pins for Degenerative Arthritis Secondary to Chronic Dorsal Thumb Dislocation in Resource-Limited Settings - A Case Report.

BACKGROUND

Chronic dislocation of the dorsal surface of the thumb metacarpophalangeal (MCP) joint is uncommon and often is accompanied by soft tissue interposition with degenerative changes, especially in delayed presentations, which are common in low resource settings.

CASE PRESENTATION: We present the case of a 21-year-old right-handed male that developed a dorsal MCP dislocation of the thumb 11 years ago with initial traditional bone setter management. He presented with pain, deformity and poor grip function. The chronic dislocation was confirmed on radiographs with secondary degenerative arthritis.

INTERVENTION: Open reduction through combined dorsal and volar approach was done. Due to severe articular degeneration, MCP arthrodesis was performed without fluoroscopic guidance by using two crossed Kirschner wires.

OUTCOME: At the 6-month follow-up, the patient achieved pain relief, stable fusion and satisfactory functional recovery, including the preservation of the grip and pinch, with acceptable cosmetic outcome.

CONCLUSION

In resource limited settings, MCP arthrodesis with K-wires without advanced intraoperative imaging may be a cost-effective and functionally acceptable way of treating neglected thumb dislocations with degenerative arthritis.