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Dislocations

Hand/upper extremity dislocations: diagnosis, reduction techniques, and open management for irreducible variants (perilunate, IP joint).

Overview

Recurrent instability following glenohumeral dislocation is most prevalent in patients aged 15 to 19 years [1], while available literature supports surgical intervention for patients under 25 to reduce re-dislocation after a first-time traumatic anterior shoulder dislocation [5]. For chronic anterior dislocation, the choice of open reduction and stabilization technique is highly variable, leading to wide outcome variations and complications such as resubluxation and early arthrosis [6]. Conversely, recurrence of acute irreducible shoulder dislocations is low when treated with open or arthroscopic procedures, with no recurrent dislocations reported in limited follow-up [4]. Recurrent instability requiring capsular reconstruction appears more prevalent in patients with a previous history of shoulder dislocation [9].

Management of acromio-clavicular joint dislocations varies by classification; Rockwood type III dislocations benefit from conservative treatment, whereas surgery improves clinical and radiological outcomes for Rockwood type IV dislocations [23]. While radiographic alignment improves with surgical repair of acute complete AC joint dislocations, there is no clear evidence that operative treatment improves short-term outcomes [16]. In the shoulder, the modified McLaughlin procedure is a reliable option for acute locked posterior dislocation with a head defect of 25–45% regarding functional outcome [47].

Dislocations in other anatomical sites present distinct challenges. Late dislocation after total hip arthroplasty is more common than previously thought, resulting from long-standing prosthesis problems, new problems, or a combination of factors [2]. Closed reduction is the treatment of choice for simultaneous triple dislocations of the small finger without associated lesions [3]. Outcomes following surgical treatment of volar fracture subluxation/dislocations of the proximal interphalangeal joint are poor, with most patients developing arthritis and some requiring salvage procedures [24]. Results using dynamic distraction external fixation for unstable fracture-dislocations of the proximal interphalangeal joint are comparable with other management techniques [27].

Anatomy & Pathophysiology

Osseous and Biomechanical Patterns

Peri-articular finger injury patterns vary significantly across the three finger joints due to distinct mechanisms of falling and local biomechanical forces [29]. In the pediatric population, fractures of the forearm, wrist, and hand represent the most frequent skeletal trauma [53]. Thumb carpometacarpal fractures and dislocations are the most common motorcycle crash injuries, likely resulting from handlebar gripping mechanics and high-energy force directed into the palm against the metacarpal base [37]. Additionally, the biomechanics of competitive jumping may predispose athletes to dislocation [60].

Ligamentous and Soft Tissue Anatomy

The anatomy of structures surrounding the metacarpophalangeal joint is variable [64], and the palmar plate is not always the anatomic structure responsible for complex dislocation of the metacarpophalangeal joint [56]. Regarding thumb stability, concomitant activation of the first dorsal interosseous and opponens pollicis acts to reduce subluxation of the thumb carpometacarpal joint in a dose-dependent fashion, with the opponens pollicis likely being the predominant reducing force [62]. For collateral ligament injuries of the thumb metacarpophalangeal joint, operative management is indicated when valgus laxity exceeds 30 degrees or is more than 15 degrees greater than in the noninjured thumb with the joint in extension [65].

Classification

Shoulder: Shoulder dislocations occur predominantly as a result of 1 of 4 distinct mechanisms [35]. Rockwood type VI acromioclavicular joint dislocations remain exceedingly rare, with only 24 cases reported to date [12].

Thumb Metacarpophalangeal Joint: Palmar dislocation of the thumb metacarpophalangeal joint is classified into three types: Type A (stable joint), Type B (tendon block), and Type C (joint instability) [33]. Traumatic dislocation of the metacarpophalangeal joint may be simple (easily reducible) or complex (requiring surgical intervention) [10].

Polydactyly: The anomaly described in Wassel Type III Polydactyly With Symphalangism does not fit into any type in the Wassel classification system [34].

Proximal Interphalangeal Joint: Fracture-dislocations of the proximal interphalangeal joint encompass a spectrum of injury severity, ranging from injuries that require little intervention to those that require advanced reconstructive surgery for optimal outcome [36].

Other Considerations: The group aged 15 to 19 years was at the highest risk of recurrent dislocation and instability [1]. Late dislocation after total hip arthroplasty can result from long-standing prosthesis problems, new problems, or a combination of factors [2]. Closed reduction is the treatment of choice for simultaneous dislocations without associated lesions [3].

Clinical Presentation

Patient demographics and injury mechanisms vary significantly by joint and context. The 15 to 19-year-old age group faces the highest risk of recurrent dislocation and instability [1]. In basketball-related shoulder dislocations, females and children are significantly more likely to present with injuries sustained via player contact [31]. Conversely, late dislocation after total hip arthroplasty is more common than previously thought, resulting from long-standing prosthesis problems, new problems, or a combination of factors [2].

Specific joint dislocations present with distinct epidemiological and clinical profiles. Traumatic dislocation of the metacarpophalangeal joint is relatively uncommon and may be simple (easily reducible) or complex (requiring surgical intervention) [10]. Carpometacarpal joint dislocations and fracture dislocations are uncommon injuries that can be very disabling if not recognized early [18]. Rockwood type VI acromioclavicular joint dislocations remain exceedingly rare, with only 24 cases reported to date [12]. Posterior shoulder dislocations are rare in the pediatric population and require a high level of suspicion for diagnosis [19]. Complete anterior dislocation of the sacro-iliac joint is a very unusual injury that can occur in skeletally mature individuals following severe trauma [20].

Clinical management is heavily influenced by timing and patient status. Early intervention and low pain levels at presentation are the two most important factors that significantly favor successful reduction of a shoulder dislocation [30].

Investigations

Plain radiography: Accurate diagnosis of hand and carpal fractures and dislocations requires appropriate imaging to limit joint stiffness while preserving mobility and function [14]. Posterior shoulder dislocations are rare in the pediatric population and require a high level of suspicion for diagnosis, as missed cases following intramedullary fixation of proximal humeral fractures can occur due to inadequate initial and postoperative x-ray images and incorrect interpretation [19, 68]. Serial radiographs may be beneficial to monitor for sequelae in pediatric posterior shoulder dislocations [19]. While radiographic alignment is improved with surgical repair of complete acromioclavicular joint dislocations, there is no clear evidence that operative treatment improves short-term outcome [16]. Late dislocation after total hip arthroplasty can result from long-standing prosthesis problems, new problems, or a combination of factors [2]. Complete anterior dislocation of the sacro-iliac joint is a very unusual injury that can occur in skeletally mature individuals following severe trauma [20].

MRI: An increased glenoid index identified via MRI may help identify patients at risk for primary or recurrent anterior glenohumeral instability events [58]. Diagnosing the cause of ulnar collateral ligament locking in the middle finger may be complicated by the lack of evidence in imaging studies [67].

Other Considerations: Patients aged 15 to 19 years are at the highest risk of recurrent dislocation and instability following glenohumeral dislocation [1]. Surgical intervention is supported for patients under the age of 25 to reduce re-dislocation following first-time traumatic anterior shoulder dislocation [5]. Closed reduction is the treatment of choice for simultaneous dislocations without associated lesions [3]. Recurrence of dislocation was low in patients treated with open or arthroscopic procedures for acute irreducible shoulder dislocations, with none reporting recurrent dislocation in limited follow-up [4]. Rockwood type VI acromioclavicular joint dislocations remain exceedingly rare, with only 24 cases reported to date [12]. When a trans-scaphoid perilunate dislocation is diagnosed late, an enduring functional result may be achieved by nonoperative treatment [13]. Carpometacarpal joint dislocations and fracture dislocations are uncommon injuries that can be very disabling if not recognized early [18]. Superior dislocation of the sternoclavicular joint can be treated nonoperatively [25]. Traumatic dislocation of the metacarpophalangeal joint may be simple (easily reducible) or complex (requiring surgical intervention) [10]. Isolated volar metacarpophalangeal dislocations can be reduced conservatively if detected early with excellent functional outcomes [66]. Open surgical treatment has traditionally been the most often used method for ulnar collateral ligament locking with a high success rate [67]. Positioning the shoulder in abduction and external rotation helps maintain reduction in pediatric posterior shoulder dislocations [19]. A short period of splinting followed by hand therapy resulted in a fully functioning hand and long finger for a patient with dorsal dislocation of the distal interphalangeal joint and volar dislocation of the metacarpophalangeal joint in the same finger [7].

Treatment

Non-Operative

Closed reduction serves as the primary treatment for simultaneous small finger dislocations without associated lesions [3], acute shoulder dislocations in pediatric patients [22], and superior sternoclavicular joint dislocations [25]. Conservative management is also viable for children with shoulder dislocations absent of Hill-Sachs and Bankart lesions [50], Rockwood type III acromioclavicular (AC) joint dislocations [23], and acute closed sagittal band injuries of the metacarpophalangeal (MCP) joint managed with extension splints [41]. Nonoperative approaches may yield enduring functional results for late-diagnosed trans-scaphoid perilunate dislocations [13], though a case of conservatively treated ulnar collateral ligament rupture of the index finger MCP joint demonstrated persistent instability after three weeks [49]. While radiographic alignment improves with surgical repair of complete AC joint dislocations, no clear evidence supports operative treatment for improved short-term outcomes [16].

Operative

Indications: Surgical intervention is supported for patients under 25 years of age to reduce re-dislocation following first-time traumatic anterior shoulder dislocation [5], and operative treatments are more effective than conservative options for preventing recurrent instability in adolescents and young adults under 40 with first-time anterior shoulder dislocation [32]. Recent studies advocate an operative approach for first-time anterior shoulder dislocation in young, active patients engaged in highly demanding sports [39]. Surgery is indicated to improve clinical and radiological outcomes in Rockwood type IV AC joint dislocations [23], whereas Rockwood type III dislocations benefit from conservative treatment [23]. Current evidence suggests operative rather than non-operative treatment of Rockwood grade III AC joint dislocations results in better cosmetic and radiological results, despite similar functional outcomes and longer time off work [38].

Surgical Approach / Technique: Open reduction and stabilization techniques for chronic anterior shoulder dislocation are highly variable and associated with a high number of complications, including resubluxation and early arthrosis [6]. Hip arthroscopy is a safe and effective modality for managing the acute and chronic sequelae of traumatic hip dislocation [26]. For acute irreducible shoulder dislocations, open or arthroscopic procedures result in low recurrence rates, with no reported recurrent dislocations in limited follow-up [4].

Other Considerations: Late dislocation after total hip arthroplasty can result from long-standing prosthesis problems, new problems, or a combination of factors [2]. Outcomes following surgical treatment of volar fracture subluxation/dislocations of the proximal interphalangeal joint associated with central slip fractures are poor, with most patients developing arthritis and some requiring salvage procedures [24]. The optimal management of subacute or chronic closed sagittal band injuries of the MCP joint remains undefined [41]. A patient with dorsal dislocation of the distal interphalangeal joint and volar dislocation of the MCP joint in the same finger achieved a fully functioning hand and long finger after short-term splinting followed by hand therapy [7].

Complications

Instability: Patients aged 15 to 19 years face the highest risk of recurrent dislocation and instability following glenohumular dislocation [1]. Almost half of all first-time shoulder dislocations in patients aged 40 years or younger will require stabilizing surgery, and two-thirds of this cohort will develop different stages of arthropathy within 25 years [17]. Recurrent instability requiring capsular reconstruction appears more prevalent in patients with a previous history of shoulder dislocation [9]. Late dislocation after total hip arthroplasty is more common than previously thought and can result from long-standing prosthesis problems, new problems, or a combination of factors [2]. The strongest patient-related factors associated with dislocation after reverse shoulder arthroplasty are a history of postoperative subluxations and having a primary diagnosis of fracture nonunion [11]. Treatment of chronic anterior shoulder dislocation using open reduction and stabilization techniques is highly variable, associated with a wide variation in outcomes, and carries a high number of complications including resubluxation and early arthrosis [6]. Conversely, recurrence of dislocation is low when patients with acute irreducible shoulder dislocations are treated with open or arthroscopic procedures, with no reported recurrent dislocations in limited follow-up [4]. In a specific case of bilateral elbow dislocation in a patient with Rubinstein-Taybi syndrome, there was no re-dislocation on the right elbow five years post-surgery [15]. Non-operated patients with primary anterior shoulder dislocation who report shoulder trouble three to six weeks after initial injury do not have less shoulder impairment (self-reported or objectively measured) than non-operated patients with recurrent anterior shoulder dislocation reporting trouble three to six weeks after their latest event [48].

Other Considerations: Hip arthroscopy is a safe and effective modality for managing the acute and chronic sequelae of traumatic hip dislocation [26]. Long-term outcomes for pelvic fractures are dependent on the pelvic ring injury and associated injuries, complicated by posterior pelvic pain and largely multifactorial factors [28]. McLaughlin's original or modified procedure is suggested for the surgical management of chronic, unreduced posterior dislocation of the shoulder (type I according to Randelli) [63].

Recovery

Light activity (weeks): Evidence does not specify a universal week range for light activity across all dislocation types; however, specific clinical scenarios inform timing. Closed reduction is the treatment of choice for simultaneous triple dislocations of the small finger without associated lesions, implying early mobilization in that context [3]. In cases of bilateral elbow dislocation in a patient with Rubinstein-Taybi syndrome, no re-dislocation occurred five years postsurgery, suggesting long-term stability is achievable [15].

Full activity (months): The timeline for full activity varies significantly by joint and pathology. For first-time shoulder dislocations in patients aged 40 years or younger, almost half will require stabilizing surgery, and two-thirds will develop different stages of arthropathy within 25 years, indicating a prolonged recovery trajectory [17]. Long-term outcomes after extension block pinning for fracture-dislocations of the proximal interphalangeal joint were satisfactory and similar to mid-term follow-up results reported 11 years earlier [52]. A patient with combined reverse perilunate and axial–ulnar dislocation of the wrist achieved excellent functional results with no major complications at 1 year follow-up [54].

Complete recovery / outcome plateau (months): Recovery plateaus and long-term outcomes are heavily dependent on specific risk factors and injury characteristics. Patients aged 15 to 19 years are at the highest risk of recurrent dislocation and instability following glenohumeral dislocation [1]. Recurrent instability requiring capsular reconstruction seems to be more prevalent in patients with a previous history of shoulder dislocation, including those with luxatio erecta [9]. In patients with locked posterior shoulder dislocation, the duration of the dislocation is the primary factor influencing clinical outcomes rather than humeral head defect size or patient age [21]. Late dislocation after total hip arthroplasty is more common than previously thought and can result from long-standing prosthesis problems, new problems, or a combination of factors [2]. The strongest patient-related factors associated with dislocation after reverse shoulder arthroplasty are a history of postoperative subluxations and having a primary diagnosis of fracture nonunion [11]. Long-term outcomes for pelvic fractures are dependent on the pelvic ring injury as well as associated injuries and are complicated by posterior pelvic pain [28]. Type I and II acromioclavicular joint disruptions impair long-term shoulder function in about half of patients 10 years after injury [51].

Rehabilitation protocol: The choice of open reduction and stabilization technique for chronic anterior dislocation is highly variable and leads to a wide variation in reported outcomes with a high number of complications such as resubluxation and early arthrosis [6]. Recurrence of dislocation was low in patients treated with open or arthroscopic procedures for acute irreducible shoulder dislocations, with none reporting recurrent dislocation in limited follow-up [4]. Historic physicians paved the way for the modern conservative treatment of shoulder dislocations [8].

Functional milestones: Validated functional trajectories are observed in specific populations. Almost half of all first-time shoulder dislocations in patients aged 40 years or younger will require stabilizing surgery, and two-thirds will develop different stages of arthropathy within 25 years [17]. In a case of bilateral elbow dislocation in a patient with Rubinstein-Taybi syndrome, there was no re-dislocation on the right elbow five years postsurgery [15].

Other Considerations: Recovery is influenced by distinct patient demographics and injury history. Patients aged 15 to 19 years are at the highest risk of recurrent dislocation and instability following glenohumeral dislocation [1]. Recurrent instability requiring capsular reconstruction seems to be more prevalent in patients with a previous history of shoulder dislocation, including those with luxatio erecta [9]. The strongest patient-related factors associated with dislocation after reverse shoulder arthroplasty are a history of postoperative subluxations and having a primary diagnosis of fracture nonunion [11].

Key Evidence

  • [L3] The group aged 15 to 19 years was at the highest risk of recurrent dislocation and instability. (10.1016/j.jse.2017.09.006)
  • [L3] Late dislocation is more common than was previously thought and can result from long-standing prosthesis problems, new problems, or a combination of factors. (10.2106/00004623-200211000-00007)
  • [L4] Closed reduction is the treatment of choice for simultaneous dislocations without associated lesions. (10.1016/j.jhsa.2012.10.043)
  • [L4] When patients were treated with an open or arthroscopic procedure, recurrence was low, with none reporting recurrent dislocation in limited follow-up. (10.1177/23259671221121633)
  • [L1] The systematic review found that the available literature supports surgical intervention in patients under the age of 25 to reduce re-dislocation. (10.1177/17585732241254693)
  • [L4] The choice of open reduction and stabilization technique for chronic anterior dislocation was highly variable and led to a wide variation in reported outcomes with a high number of complications such as resubluxation and early arthrosis. (10.1016/j.jse.2020.10.010)
  • [Case_report] The patient's outcome after a short period of splinting, followed by hand therapy, resulted in a fully functioning hand and long finger. (10.1007/s11552-009-9218-3)
  • [L5] This review demonstrates that historic physicians paved the way for the modern conservative treatment of shoulder dislocations. (10.1177/17585732211058407)
  • [L4] Recurrent instability requiring capsular reconstruction seems to be more prevalent in patients with a previous history of shoulder dislocation. (10.1016/j.jse.2009.07.062)
  • [L5] Traumatic dislocation of the metacarpophalangeal joint is a relatively uncommon injury that may be simple (easily reducible) or complex (requiring surgical intervention). (10.5435/00124635-200905000-00006)
  • [L3] The strongest patient-related factors associated with dislocation were a history of postoperative subluxations and having a primary diagnosis of fracture nonunion. (10.1016/j.jse.2023.05.028)
  • [L5] RW type VI AC dislocations remain exceedingly rare, with only 24 cases reported to date. (10.1016/j.jisako.2025.101042)
  • [L4] The authors conclude that when this injury is diagnosed late, an enduring functional result may be achieved by nonoperative treatment. (10.1016/j.jhsa.2007.05.003)
  • [Case_report] There has been no re-dislocation on the right elbow, five years postsurgery, and we hope that our experience will help clinicians in the future when treating patients with similar conditions. (10.1016/j.jseint.2023.03.021)
  • [L1] While radiographic alignment is improved with surgical repair, there is no clear evidence that operative treatment improves short-term outcome for complete AC joint dislocations. (10.1016/j.jse.2012.12.051)
  • [L2] Almost half of all first-time dislocations at the age of <25 years will have stabilising surgery and two-thirds will develop different stages of arthropathy within 25 years. (10.1007/s00167-015-3980-2)
  • [L5] Carpometacarpal joint dislocations and fracture dislocations are uncommon injuries that can be very disabling if not recognized early. (10.5435/jaaos-d-25-00583)
  • [Case_report] Posterior shoulder dislocations are rare in the pediatric population and require a high level of suspicion for diagnosis; positioning the shoulder in abduction and external rotation helps maintain reduction, and serial radiographs may be beneficial to monitor for sequelae. (10.1016/j.xrrt.2020.12.003)
  • [Case_report] Complete anterior dislocation of the sacro-iliac joint is a very unusual injury that can occur in skeletally mature individuals following severe trauma. (10.2106/00004623-197658010-00028)
  • [L4] In patients with locked posterior shoulder dislocation, the primary factor influencing clinical outcomes is the duration of the dislocation, rather than humeral head defect size or patient age. (10.1186/s12891-025-08886-4)
  • [L3] The most common treatment for a shoulder dislocation in paediatric patients is a closed shoulder reduction. (10.3390/ijerph17082834)
  • [L4] Surgery improves the clinical and radiological outcome in Rockwood type IV dislocations, whereas Rockwood type III dislocations benefit from conservative treatment. (10.1007/s00167-020-06423-5)
  • [L4] Outcomes following surgical treatment of the volar fracture subluxation/dislocation are poor, with most patients developing arthritis and some requiring salvage procedures. (10.1016/j.jhsa.2017.03.030)
  • [L4] Superior dislocation of the SCJ can be treated nonoperatively. (10.1016/j.jse.2007.02.126)
  • [L5] Hip arthroscopy is a safe and effective modality for management of the acute and chronic sequelae of traumatic hip dislocation. (10.5435/jaaos-d-15-00088)
  • [L4] Our results are comparable with other techniques used in the management of unstable PIP joint fracture-dislocations. (10.1016/j.jhsa.2007.07.018)
  • [L4] The patterns of peri-articular finger injuries differ greatly between the three finger joints, explained by the mechanism of falling and local biomechanical forces. (10.1177/17531934251381203)
  • [L1] Early intervention and low pain levels at presentation were the two most important factors that significantly favor successful reduction of a shoulder dislocation. (10.1016/j.jse.2012.01.004)
  • [L4] Females and children were significantly more likely to present with a dislocation by sustaining player contact. (10.1016/j.jse.2024.07.040)
  • [L1] Surgical treatments are more effective than conservative options in preventing recurrent instability in adolescents and young adults under 40 years of age with first-time anterior shoulder dislocation. (10.1016/j.arthro.2025.07.044)
  • [L4] Palmar dislocation of the thumb metacarpophalangeal joint is classified into three types: Type A (stable joint), Type B (tendon block), and Type C (joint instability). (10.1177/1753193413499291)
  • [L4] The anomaly described does not fit into any type in the Wassel classification system. (10.1016/j.jhsa.2014.02.028)
  • [L4] Shoulder dislocations have now been shown to occur predominantly as a result of 1 of 4 distinct mechanisms, most frequently in the second half of the game. (10.1177/0363546519882412)
  • [L5] Fracture-dislocations of the proximal interphalangeal joint encompass a spectrum of injury severity, ranging from injuries that require little intervention to those that require advanced reconstructive surgery for optimal outcome. (10.5435/jaaos-21-02-88)
  • [L4] Carpometacarpal fractures and dislocations are the most frequent motorcycle crash thumb injury, probably due to the mechanics of gripping handlebars and the high-energy force directed into the palm and against the metacarpal base. (10.1177/1753193415620186)
  • [L2] Current evidence suggests that operative rather than non-operative treatment of Rockwood grade III dislocations results in better cosmetic and radiological results, similar functional outcomes and longer time off work. (10.1302/0301-620x.95b12.31802)
  • [L5] Recent studies suggest an operative approach to the first-time anterior dislocation of the shoulder, especially if the patient is young, active, and involved in highly demanding sports. (10.1007/s00167-009-0950-6)
  • [L5] Many acute injuries can be managed nonsurgically with extension splints, while optimal management of subacute or chronic injuries remains undefined. (10.5435/jaaos-d-13-00203)
  • [L4] With respect to functional outcome, modified McLaughlin procedure is a reliable option for the treatment of acute locked posterior shoulder dislocation with a head defect of 25–45%. (10.1007/s00167-012-2217-x)
  • [L4] Non-operated patients with primary anterior shoulder dislocation and self-reported shoulder trouble three-six weeks after initial injury do not have less shoulder impairment (self-reportedly or objectively measured) than non-operated patients with recurrent anterior shoulder dislocation and self-reported shoulder trouble three-six weeks after their latest shoulder dislocation event. (10.1186/s12891-019-2444-0)
  • [L4] The case reported here was initially treated conservatively, but instability was still present after 3 weeks. (10.1054/jhsb.1999.0334)
  • [Case_report] The absence of Hill-Sachs and Bankart lesions in this pediatric patient suggests that conservative treatment is a viable option for managing shoulder dislocation in children. (10.1016/j.xrrt.2024.01.012)
  • [L4] Type I and II acromioclavicular joint disruptions impair long-term shoulder function in about half of patients 10 years after injury. (10.1177/0363546508319047)
  • [L4] The long-term outcomes were satisfactory and similar to the mid-term follow-up results of the same patient cohort reported 11 years earlier. (10.1177/17531934221102251)
  • [Case_report] The patient achieved excellent functional results with no major complications at 1 year follow-up. (10.1177/1753193408091348)
  • [Case_report] The palmar plate is not always the anatomic structure responsible for complex dislocation of the MCP joint. (10.1016/j.jhsa.2007.12.018)
  • [L3] This useful MRI measurement may help identify patients at risk for primary or recurrent anterior glenohumeral instability events and may therefore help with guiding treatment and prevention. (10.1177/2325967120986139)
  • [L4] Furthermore, the biomechanics of competitive jumping may make these athletes more prone to dislocation and require more conservative return-to-sport recommendations. (10.1016/j.arthro.2014.04.099)
  • [L5] Concomitant activation of the FDI and OP acts to reduce subluxation of the thumb CMC joint in a dose-dependent fashion, with the OP likely being the predominant reducing force. (10.1177/1558944717691132)
  • [L4] McLaughlin's original or modified procedure is suggested for chronic, unreduced posterior dislocation of the shoulder (type I according to Randelli). (10.1007/s00167-004-0524-6)
  • [L5] The anatomy of the structures surrounding the MCP joint is variable, and careful dissection to prevent iatrogenic injuries is mandatory. (10.1016/j.jhsa.2009.06.001)
  • [L5] Valgus laxity greater than 30 degrees or more than 15 degrees more than in the noninjured thumb with the MCP joint in extension is an indication for operative management. (10.5435/00124635-201105000-00006)
  • [L4] Isolated volar MCP dislocations can be reduced conservatively if detected early with excellent functional outcomes. (10.1016/j.jhsg.2021.04.001)
  • [L4] Although diagnosing the cause of UCL locking may be complicated by the lack of evidence in imaging studies, open surgical treatment has traditionally been the most often used with a high success rate. (10.1016/j.jhsg.2022.08.003)
  • [L4] Missed posterior dislocation of the shoulder after intramedullary fixation of proximal humeral fractures is an extremely rare injury that can be missed due to inadequate initial and postoperative x-ray images and incorrect interpretation. (10.1016/j.jse.2008.10.020)

See Also

References

[1] Epidemiology of glenohumeral dislocation and subsequent instability in an urban population. Journal of Shoulder and Elbow Surgery. 2018. DOI: 10.1016/j.jse.2017.09.006

[2] LATE DISLOCATION AFTER TOTAL HIP ARTHROPLASTY. The Journal of Bone and Joint Surgery-American Volume. 2002. DOI: 10.2106/00004623-200211000-00007

[3] Simultaneou Triple Dislocation of the Small Finger. The Journal of Hand Surgery. 2013. DOI: 10.1016/j.jhsa.2012.10.043

[4] A Systematic Review of Acute Irreducible Shoulder Dislocations in the 21st Century. Orthopaedic Journal of Sports Medicine. 2022. DOI: 10.1177/23259671221121633

[5] A systematic review and meta-analysis of operative versus non-operative management for first time traumatic anterior shoulder dislocation in young adults. Shoulder & Elbow. 2024. DOI: 10.1177/17585732241254693

[6] Results and complications of head-preserving techniques in chronic neglected shoulder dislocation: a systematic review. Journal of Shoulder and Elbow Surgery. 2021. DOI: 10.1016/j.jse.2020.10.010

[7] Dorsal Dislocation of the Distal Interphalangeal Joint and Volar Dislocation of the Metacarpophalangeal Joint in the Same Finger: A Case Report. HAND. 2009. DOI: 10.1007/s11552-009-9218-3

[8] History of closed reduction techniques and initial management for shoulder dislocations: From classical antiquity to modern times. Shoulder & Elbow. 2021. DOI: 10.1177/17585732211058407

[9] Results of treatment of luxatio erecta (inferior shoulder dislocation). Journal of Shoulder and Elbow Surgery. 2010. DOI: 10.1016/j.jse.2009.07.062

[10] Metacarpophalangeal Joint Dislocation. Journal of the American Academy of Orthopaedic Surgeons. 2009. DOI: 10.5435/00124635-200905000-00006

[11] Predictors of dislocations after reverse shoulder arthroplasty: a study by the ASES complications of RSA multicenter research group. Journal of Shoulder and Elbow Surgery. 2024. DOI: 10.1016/j.jse.2023.05.028

[12] Rockwood type VI acromioclavicular joint dislocations: A systematic review. Journal of ISAKOS. 2026. DOI: 10.1016/j.jisako.2025.101042

[13] Long-Term Follow-Up of an Undiagnosed Trans-Scaphoid Perilunate Dislocation Demonstrating Articular Remodeling and Functional Adaptation. The Journal of Hand Surgery. 2007. DOI: 10.1016/j.jhsa.2007.05.003

[14] Chapter 29 Hand/Carpal Fractures and Dislocations. 2021.

[15] A case of bilateral elbow dislocation in a patient with Rubinstein-Taybi syndrome. JSES International. 2023. DOI: 10.1016/j.jseint.2023.03.021

[16] Operative vs. Non-Operative Treatment of Acute Dislocations of the Acromio-Clavicular Joint: Results of a Multi-Centre Randomized, Prospective Clinical Trial. Journal of Shoulder and Elbow Surgery. 2013. DOI: 10.1016/j.jse.2012.12.051

[17] Primary anterior dislocation of the shoulder: long-term prognosis at the age of 40 years or younger. Knee Surgery, Sports Traumatology, Arthroscopy. 2016. DOI: 10.1007/s00167-015-3980-2

[18] Carpometacarpal Joint Dislocations and Fracture Dislocations of the Index Through Small Digits. Journal of the American Academy of Orthopaedic Surgeons. 2025. DOI: 10.5435/jaaos-d-25-00583

[19] Case report: pediatric posterior shoulder dislocation. JSES Reviews, Reports, and Techniques. 2021. DOI: 10.1016/j.xrrt.2020.12.003

[20] Complete anterior dislocation of the sacro-iliac joint. A case report. The Journal of Bone & Joint Surgery. 1976. DOI: 10.2106/00004623-197658010-00028

[21] The duration of dislocation is the most important prognostic factor in chronic locked posterior shoulder dislocations treated with the modified McLaughlin surgical procedure: a multicentre study. BMC Musculoskeletal Disorders. 2025. DOI: 10.1186/s12891-025-08886-4

[22] Epidemiology of Paediatric Shoulder Dislocation: A Nationwide Study in Italy from 2001 to 2014. International Journal of Environmental Research and Public Health. 2020. DOI: 10.3390/ijerph17082834

[23] Surgery improves the clinical and radiological outcome in Rockwood type IV dislocations, whereas Rockwood type III dislocations benefit from conservative treatment. Knee Surgery, Sports Traumatology, Arthroscopy. 2021. DOI: 10.1007/s00167-020-06423-5

[24] The Central Slip Fracture: Results of Operative Treatment of Volar Fracture Subluxations/Dislocations of the Proximal Interphalangeal Joint. The Journal of Hand Surgery. 2017. DOI: 10.1016/j.jhsa.2017.03.030

[25] Superior dislocation of the sternoclavicular joint. Journal of Shoulder and Elbow Surgery. 2008. DOI: 10.1016/j.jse.2007.02.126

[26] Arthroscopic Treatment of Traumatic Hip Dislocation. Journal of the American Academy of Orthopaedic Surgeons. 2016. DOI: 10.5435/jaaos-d-15-00088

[27] Use of Dynamic Distraction External Fixation for Unstable Fracture-Dislocations of the Proximal Interphalangeal Joint. The Journal of Hand Surgery. 2008. DOI: 10.1016/j.jhsa.2007.07.018

[28] Chapter 32 Pelvic Fractures: Definitive Treatment and Outcomes. 2021.

[29] Is there a difference in the types of injuries occurring around each finger joint after a fall?. Journal of Hand Surgery (European Volume). 2025. DOI: 10.1177/17531934251381203

[30] Milch versus Stimson technique for nonsedated reduction of anterior shoulder dislocation: a prospective randomized trial and analysis of factors affecting success. Journal of Shoulder and Elbow Surgery. 2012. DOI: 10.1016/j.jse.2012.01.004

[31] Sex and age-specific analysis of basketball-related shoulder dislocations in the United States: a national injury data review. Journal of Shoulder and Elbow Surgery. 2025. DOI: 10.1016/j.jse.2024.07.040

[32] Surgical Treatment Is Superior to Conservative Options in Preventing Recurrence of First-Time Anterior Shoulder Dislocation in Adolescents and Adults Under 40 Years of Age: A Systematic Review and Network Meta-analysis. Arthroscopy: The Journal of Arthroscopic & Related Surgery. 2025. DOI: 10.1016/j.arthro.2025.07.044

[33] Palmar dislocation of the thumb metacarpophalangeal joint: report of four cases and a review of the literature. Journal of Hand Surgery (European Volume). 2013. DOI: 10.1177/1753193413499291

[34] Wassel Type III Polydactyly With Symphalangism: A Rare Entity. The Journal of Hand Surgery. 2014. DOI: 10.1016/j.jhsa.2014.02.028

[35] Video Analysis of Shoulder Dislocations in Rugby: Insights Into the Dislocating Mechanisms. The American Journal of Sports Medicine. 2019. DOI: 10.1177/0363546519882412

[36] Fracture-dislocations of the Proximal Interphalangeal Joint. Journal of the American Academy of Orthopaedic Surgeons. 2013. DOI: 10.5435/jaaos-21-02-88

[37] Motorcyclist’s thumb: carpometacarpal injuries of the thumb sustained in motorcycle crashes. Journal of Hand Surgery (European Volume). 2016. DOI: 10.1177/1753193415620186

[38] Controversies relating to the management of acromioclavicular joint dislocations. The Bone & Joint Journal. 2013. DOI: 10.1302/0301-620x.95b12.31802

[39] Primary anterior shoulder dislocation in young athletes: fix them!. Knee Surgery, Sports Traumatology, Arthroscopy. 2009. DOI: 10.1007/s00167-009-0950-6

[41] Closed Sagittal Band Injury of the Metacarpophalangeal Joint. Journal of the American Academy of Orthopaedic Surgeons. 2015. DOI: 10.5435/jaaos-d-13-00203

[47] Excellent results of lesser tuberosity transfer in acute locked posterior shoulder dislocation. Knee Surgery, Sports Traumatology, Arthroscopy. 2012. DOI: 10.1007/s00167-012-2217-x

[48] Patients with non-operated traumatic primary or recurrent anterior shoulder dislocation have equally poor self-reported and measured shoulder function: a cross-sectional study. BMC Musculoskeletal Disorders. 2019. DOI: 10.1186/s12891-019-2444-0

[49] Rupture of the Ulnar Collateral Ligament of the Metacarpophalangeal Joint of the Index Finger. Journal of Hand Surgery. 2000. DOI: 10.1054/jhsb.1999.0334

[50] Anterior shoulder dislocation and clavicle fracture in a 6-year-old boy: a case report and literature review. JSES Reviews, Reports, and Techniques. 2024. DOI: 10.1016/j.xrrt.2024.01.012

[51] Long-Term Shoulder Function after Type I and II Acromioclavicular Joint Disruption. The American Journal of Sports Medicine. 2008. DOI: 10.1177/0363546508319047

[52] Long-term outcomes after extension block pinning for fracture-dislocations of the proximal interphalangeal joint. Journal of Hand Surgery (European Volume). 2022. DOI: 10.1177/17531934221102251

[53] Chapter 54 Pediatric Forearm, Wrist, and Hand Trauma. 2020.

[54] Combined Reverse Perilunate and Axial–Ulnar Dislocation of the Wrist: A Case Report. Journal of Hand Surgery (European Volume). 2008. DOI: 10.1177/1753193408091348

[56] Complex Dorsal Metacarpophalangeal Joint Dislocation Caused by Interosseous Tendon Entrapment: Case Report. The Journal of Hand Surgery. 2008. DOI: 10.1016/j.jhsa.2007.12.018

[58] Increased Glenoid Index as a Risk Factor for Pediatric and Adolescent Anterior Glenohumeral Dislocation: An MRI-Based, Case-Control Study. Orthopaedic Journal of Sports Medicine. 2021. DOI: 10.1177/2325967120986139

[60] Anterior Hip Dislocation 5 Months After Hip Arthroscopy. Arthroscopy. 2014. DOI: 10.1016/j.arthro.2014.04.099

[62] Radiographic Analysis of Simulated First Dorsal Interosseous and Opponens Pollicis Loading Upon Thumb CMC Joint Subluxation: A Cadaver Study. HAND. 2017. DOI: 10.1177/1558944717691132

[63] Surgical management of chronic, unreduced posterior dislocation of the shoulder. Knee Surgery, Sports Traumatology, Arthroscopy. 2004. DOI: 10.1007/s00167-004-0524-6

[64] A Cadaver Model That Investigates Irreducible Metacarpophalangeal Joint Dislocation. The Journal of Hand Surgery. 2009. DOI: 10.1016/j.jhsa.2009.06.001

[65] Collateral Ligament Injuries of the Thumb Metacarpophalangeal Joint. Journal of the American Academy of Orthopaedic Surgeons. 2011. DOI: 10.5435/00124635-201105000-00006

[66] Volar Metacarpophalangeal Dislocation of Fingers: Review of the Literature. Journal of Hand Surgery Global Online. 2021. DOI: 10.1016/j.jhsg.2021.04.001

[67] Middle Finger Metacarpophalangeal Joint Locked in Flexion Caused by Entrapped Ulnar Collateral Ligament. Journal of Hand Surgery Global Online. 2022. DOI: 10.1016/j.jhsg.2022.08.003

[68] Missed posterior dislocation of the shoulder after intramedullary fixation of humeral fractures: A report of three cases. Journal of Shoulder and Elbow Surgery. 2009. DOI: 10.1016/j.jse.2008.10.020

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