Neglected volar dislocation of the thumb metacarpophalangeal joint: A case report with review of literature.

BACKGROUND

Volar dislocation of the metacarpophalangeal (MCP) joint of the thumb is an exceptionally rare injury due to the joint's inherent stability provided by the volar plate, collateral ligaments, and dorsal capsule. Chronic or neglected dislocations are even more uncommon and pose considerable surgical challenges because of fibrosis, soft tissue contracture, and adaptive bony changes.

CASE PRESENTATION: We report the case of a 12-year-old boy who presented with a nine-year history of progressive deformity and restricted motion of the left thumb following blunt trauma with a wooden stick. Radiographs revealed a neglected volar dislocation of the thumb MCP joint with dorsal projection of the metacarpal head. Open reduction via a dorsal approach was performed under loupe magnification. Interposed fibrotic tissue and contracted structures were released, the extensor tendons were realigned, and ligamentous stability was restored. A uniplanar external fixator was applied to maintain joint congruity, followed by physiotherapy after fixator removal.

RESULTS

At six months postoperatively, the patient achieved full correction of deformity, restoration of joint stability, and significant improvement in thumb motion, enabling normal daily activity.

CONCLUSION

Volar dislocation of the thumb MCP joint is extremely rare, particularly in pediatric patients. Early recognition and meticulous surgical management with soft tissue release, ligament repair, and stable fixation can yield excellent functional recovery even in long-standing cases. This report adds to the limited literature on chronic volar MCP dislocations and underscores the value of timely surgical intervention and structured rehabilitation.