DIAGNOSIS AND MANAGEMENT OF METACARPOPHALANGEAL JOINT LOCKING WITH EXTENSION LAG_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

LIUKun ,  XIONGGe , YANGChen , TIANWen , TIANGuanglei

Department of Hand Surgery, Beijing Jishuitan Hospital, the 4th Medical College of Peking University, Beijing, 100035, P. R. China;

Corresponding author：

XIONGGe, Email: xiongge@sohu.com

Keywords：

Metacarpophalangeal joint; Joint locking; Extension lag

DOI：

10.7507/1002-1892.20140287

Video：

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Objective To investigate the cl inical characteristics, diagnosis, and treatment of metacarpophalangeal (MCP) joint locking with extension lag. Methods Between February 2009 and April 2014, 17 patients (17 fingers) with MCP joint locking with extension lag were treated. The patients included 4 males and 13 females, and the average age was 40.7 years (range, 20-72 years). The index finger was locked in 12 cases and the middle finger in 5 cases. All patients could not fully extend the MCP joint at about 30° flexion without flexion limitation of the interphalangeal joint. The range of motion (ROM) of the MCP joint was (41.2±5.1)°. The visual analogue scale (VAS) score was 2.7±0.5. X-ray and CT scanning showed that there was a bony prominence on radial condyle of the metacarpal head in 15 primary patients, and a hook like osteophyte on ulnar condyle in 2 degenerative patients. All patients were treated with close reduction first, and open reduction was conducted when the manipulation failed. Results Successful close reduction was achieved in 5 cases, and successful open reduction in 8 cases; 4 cases gave up treatment after failure for close reduction. All patients who achieved successful reduction were followed up 2.3 years on average (range, 6 months to 5 years and 2 months). The ROM of the MCP joint was increased to (80.4±6.6)° at last follow-up, showing significant difference when compared with ROM before reduction (t=-19.46, P=0.00). The VAS score decreased to 0.2±0.4 at last follow-up, also showing significant difference when compared with score before reduction (t=13.44, P=0.00). Conclusion Accessory collateral ligament caught at the bony prominence on the radial condyle of the metacarpal head is the most common cause of the MCP joint locking with extension lag. Close reduction is feasible, but recurrence of locking is possible. Surgical treatment is advised in the event of manipulation failure or recurrent locking.

Citation： LIUKun, XIONGGe, YANGChen, TIANWen, TIANGuanglei. DIAGNOSIS AND MANAGEMENT OF METACARPOPHALANGEAL JOINT LOCKING WITH EXTENSION LAG. Chinese Journal of Reparative and Reconstructive Surgery, 2014, 28(11): 1325-1328. doi: 10.7507/1002-1892.20140287 Copy

1.	田光磊, 公铁军, 王澍寰, 等.手指掌指关节绞锁的诊断及治疗.中华骨科杂志, 1994, 14(7):445-447.
2.	Thomsen L, Roulot E, Barbato B, et al. Locked metacarpophalangeal joint of long fingers:classification, definition and treatment based on 15 cases and literature review. Chir Main, 2011, 30(4):269-275.
3.	Yagi M, Yamanaka K, Yoshida K, et al. Successful manual reduction of locked metacarpophalangeal joints in fingers. J Bone Joint Surg (Am), 2000, 82(3):366-371.
4.	Posner MA, Langa V, Green SM. The locked metacarpophalangeal joint:diagnosis and treatment. J Hand Surg (Am), 1986, 11(2):249-253.
5.	Taylor TK. Locked index finger. Aust N Z J Surg, 1963, 33:103-107.
6.	Harvey FJ. Locking of the metacarpo-phalangeal joints. J Bone Joint Surg (Br), 1974, 56(1):156-159.
7.	Atlan F, Oberlin C, Durand S. Locked metacarpophalangeal joint associated with PAX2 gene mutation:a case report. J Hand Surg (Eur Vol), 2010, 35(6):517-519.
8.	王大立, 王辉.示指掌指关节绞锁2例.中外医学研究, 2013, 11(16): 151.
9.	Goyal K, Imbriglia J. Metacarpophalangeal joint locking in 3 family members with brachymesophalangy:case report. J Hand Surg (Am), 2014, 39(6):1094-1097.
10.	Inoue G, Miura T. Locked metacarpophalangeal joint of the finger. Orthop Rev, 1991, 20(2):149-153.
11.	Rankin EA, Uwagie-Ero S. Locking of the metacarpophalangeal joint. J Hand Surg (Am), 1986, 11(6):868-871.
12.	杨通, 芮永军. 2-5指掌指关节的解剖学研究进展.实用手外科杂志, 2014, 28(1):75-79.
13.	Eo S, Jones NF. Locking of the index finger metacarpophalangeal joint due to a chronic osteochondral fracture fragment of the metacarpal head:a case report. Hand (NY), 2012, 7(4):450-453.
14.	Keramidas E. Manual reduction of the locked metacarpophalangeal joint combined with intra-articular injection of normal sal ine. Plast Reconstr Surg, 2005, 115(7):2164-2165.
15.	张光洪.自发性手掌指关节交锁10例临床分析.实用诊断与治疗杂志, 2003, 17(4):329.
16.	Gilligan P, Hegarty D, Bradley P, et al. A case report and review of the locked metacarpophalangeal joint. Accid Emerg Nurs, 2003, 11(2): 103-105.
17.	施海峰, 芮永军, 张全荣, 等.原发性掌指关节交锁症的临床分析.中国骨与关节损伤杂志, 2010, 25(3):249-250.
18.	Thomas RJ, Pannunzio ME, Miller MD, et al. Locked metacarpophalangeal joint in a 20-year-old football player:a case report. Am J Sports Med, 2006, 34(1):29-31.
19.	Hamada Y, Sairyo K, Yasui N. Locking of the metacarpophalangeal joint as a result of the shape of the metacarpal head in achondroplasia. J Hand Surg (Eur Vol), 2007, 32(5):588-590.
20.	Kim JK, Chung MS, Baek GH. Locked metacarpophalangeal joint of the index finger:consideration about the surgical approach. J Hand Surg (Eur Vol), 2009, 34(2):278-280.

1. 田光磊, 公铁军, 王澍寰, 等.手指掌指关节绞锁的诊断及治疗.中华骨科杂志, 1994, 14(7):445-447.
2. Thomsen L, Roulot E, Barbato B, et al. Locked metacarpophalangeal joint of long fingers:classification, definition and treatment based on 15 cases and literature review. Chir Main, 2011, 30(4):269-275.
3. Yagi M, Yamanaka K, Yoshida K, et al. Successful manual reduction of locked metacarpophalangeal joints in fingers. J Bone Joint Surg (Am), 2000, 82(3):366-371.
4. Posner MA, Langa V, Green SM. The locked metacarpophalangeal joint:diagnosis and treatment. J Hand Surg (Am), 1986, 11(2):249-253.
5. Taylor TK. Locked index finger. Aust N Z J Surg, 1963, 33:103-107.
6. Harvey FJ. Locking of the metacarpo-phalangeal joints. J Bone Joint Surg (Br), 1974, 56(1):156-159.
7. Atlan F, Oberlin C, Durand S. Locked metacarpophalangeal joint associated with PAX2 gene mutation:a case report. J Hand Surg (Eur Vol), 2010, 35(6):517-519.
8. 王大立, 王辉.示指掌指关节绞锁2例.中外医学研究, 2013, 11(16): 151.
9. Goyal K, Imbriglia J. Metacarpophalangeal joint locking in 3 family members with brachymesophalangy:case report. J Hand Surg (Am), 2014, 39(6):1094-1097.
10. Inoue G, Miura T. Locked metacarpophalangeal joint of the finger. Orthop Rev, 1991, 20(2):149-153.
11. Rankin EA, Uwagie-Ero S. Locking of the metacarpophalangeal joint. J Hand Surg (Am), 1986, 11(6):868-871.
12. 杨通, 芮永军. 2-5指掌指关节的解剖学研究进展.实用手外科杂志, 2014, 28(1):75-79.
13. Eo S, Jones NF. Locking of the index finger metacarpophalangeal joint due to a chronic osteochondral fracture fragment of the metacarpal head:a case report. Hand (NY), 2012, 7(4):450-453.
14. Keramidas E. Manual reduction of the locked metacarpophalangeal joint combined with intra-articular injection of normal sal ine. Plast Reconstr Surg, 2005, 115(7):2164-2165.
15. 张光洪.自发性手掌指关节交锁10例临床分析.实用诊断与治疗杂志, 2003, 17(4):329.
16. Gilligan P, Hegarty D, Bradley P, et al. A case report and review of the locked metacarpophalangeal joint. Accid Emerg Nurs, 2003, 11(2): 103-105.
17. 施海峰, 芮永军, 张全荣, 等.原发性掌指关节交锁症的临床分析.中国骨与关节损伤杂志, 2010, 25(3):249-250.
18. Thomas RJ, Pannunzio ME, Miller MD, et al. Locked metacarpophalangeal joint in a 20-year-old football player:a case report. Am J Sports Med, 2006, 34(1):29-31.
19. Hamada Y, Sairyo K, Yasui N. Locking of the metacarpophalangeal joint as a result of the shape of the metacarpal head in achondroplasia. J Hand Surg (Eur Vol), 2007, 32(5):588-590.
20. Kim JK, Chung MS, Baek GH. Locked metacarpophalangeal joint of the index finger:consideration about the surgical approach. J Hand Surg (Eur Vol), 2009, 34(2):278-280.

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DIAGNOSIS AND MANAGEMENT OF METACARPOPHALANGEAL JOINT LOCKING WITH EXTENSION LAG

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