How to evaluate a traumatic arthroscopy of the metacarpophalangeal (MCP) joint with a laceration?

From the Guidelines

Evaluation of a traumatic arthroscopy MCP laceration should begin with radiographs to identify fractures, foreign bodies, or joint abnormalities, as recommended by the American College of Radiology 1. When evaluating a traumatic arthroscopy MCP laceration, it is essential to consider the potential for internal joint damage and external wound complications.

• A thorough history of the injury mechanism, timing, and any previous hand injuries should be obtained.
• A complete examination should be performed, assessing the wound characteristics, joint stability, neurovascular status, and tendon function.
• The wound should be cleaned carefully with normal saline or antiseptic solution to allow proper visualization.
• Testing for joint capsule violation should be done by looking for clear synovial fluid expression or performing a saline load test, where sterile saline is injected into the joint space and observed for leakage through the wound.
• According to the American College of Radiology, radiography is always indicated as the initial imaging for suspected acute hand and wrist trauma, including a standard 3-view radiographic examination of the hand to show most fractures and dislocations of the metacarpals and phalanges 1.
• If joint involvement is confirmed, orthopedic consultation is warranted for possible surgical intervention.
• Tetanus prophylaxis should be provided if needed, and antibiotic prophylaxis should be considered with cephalexin or clindamycin for penicillin-allergic patients.
• Joint-involving lacerations typically require surgical debridement, irrigation, and repair in the operating room to prevent infection and preserve function.
• Post-repair management includes elevation, immobilization for 10-14 days, followed by early protected range of motion exercises to prevent stiffness while allowing healing, as these injuries can lead to septic arthritis, chronic pain, and permanent functional impairment if not properly managed.

From the Research

Evaluation of Traumatic Arthroscopy MCP Laceration

To evaluate traumatic arthroscopy MCP laceration, several factors should be considered:

• The anatomy of the MCP joint and the extent of the laceration 2
• The use of arthroscopy in diagnosing and treating MCP joint pathology, including fractures and ligament injuries 2, 3
• The potential benefits of arthroscopic treatment, including minimal soft tissue disruption and reduced complications compared to open approaches 2, 4
• The importance of considering MCP arthroplasty in cases of open MCP joint trauma to preserve motion, prevent pain, and avoid fusion 3

Indications and Techniques for MCP Arthroscopy

MCP arthroscopy can be used to treat a variety of conditions, including:

• Acute fractures of the metacarpal or proximal phalanx 4
• Collateral tears, both acute and chronic 4
• Traumatic nonreconstructible articular cartilage loss 3 The technique for MCP arthroscopy involves the use of specialized equipment and a thorough understanding of the anatomy of the MCP joint 2, 5

Clinical Outcomes and Complications

Studies have shown that MCP arthroscopy can result in excellent clinical outcomes, including:

• Preservation of adequate MCP joint motion 3
• Little or no pain at follow-up 3
• Low complication rates, including infection and revision surgery 3, 4 However, some patients may require additional procedures, such as tenolysis, to achieve optimal results 3