Kaplan's Lesion – Functional and Radiological Outcome of Open Reduction by Dorsal Approach: A Case Series.

Abstract

Background:Kaplan's lesion is an uncommon complex dorsal dislocation of the metacarpophalangeal (MCP) joint caused by forceful hyperextension, with interposition of the volar plate and surrounding soft tissues. Closed reduction frequently fails, requiring open reduction. This case series describes the clinical, functional, and radiological outcomes following dorsal open reduction.   Case Presentation:Five adult male patients with complex dorsal dislocation of the index MCP joint were treated at PRM Medical College and Hospital, Baripada, Odisha, between January 2022 and August 2023, with a minimum follow-up of one year. All injuries resulted from road traffic accidents, and closed reduction failed in all cases. Three patients underwent mobilization of the volar plate using a thin osteotome, while two delayed cases required longitudinal splitting of the volar plate. Stable reduction was achieved in all patients, with K-wire fixation as required. One patient with an associated osteochondral fragment underwent fixation with two K-wires.   Conclusion:At one-year follow-up, all patients maintained anatomical reduction and joint congruity. Mean VAS pain score decreased from 8.6 to 0.4, while mean MCP flexion improved from 0° to 82°. All patients returned to their pre-injury occupations within three months, with no redislocation, infection, neurovascular injury, or revision surgery.   Take-away Lessons:When closed reduction fails, early recognition and open reduction of Kaplan's lesion are important. The dorsal approach allows direct management of the entrapped volar plate and can provide stable reduction and satisfactory functional recovery.