Finger dislocations account for less than 5% of upper extremity injuries. They are mostly dorsal, caused by violent hyperextension of the metacarpophalangeal (MCP) joint. The purpose of this study is to present a rare case of complex/irreducible dorsal MCP dislocation of the little finger that was treated with open reduction by a volar approach.

A 48-year-old man presented to the emergency department after an injury to his left hand while he was playing football. On examination, the patient displayed pain, tenderness and deformity over the MCP joint of the left little finger. The range of motion was also restricted. On X-rays, the diagnosis of dorsal dislocation of the MCP joint was confirmed. After two unsuccessful attempts for closed reduction, the patient was posted for surgery. Through a volar approach under general anesthesia, a release of the A1 pulley was initially performed. The reduction was still difficult as the ruptured volar plate was entrapped between the proximal phalanx and the metacarpal head. After reduction of the entrapped volar plate, the proximal phalanx was easily reduced and the volar plate was reconstructed using absorbable suture. Afterwards, the MCP joint was stabilized in a 45°angle with a K-wire from dorsal to volar, which was removed 15 days later.

After K-wire removal, the patient started progressive mobilization of the little finger until its full range of motion. Two months postoperatively the patient had restored full range of motion without pain and managed to return to his pre-injury activities.

Although MCP joint dislocations can be easily diagnosed, they should not be underestimated in terms of their management.

In cases where closed reduction is not possible, an open reduction and stabilization is recommended.