Management of Kaplan's Dislocation by Open Dorsal Approach

Objective: To evaluate the efficacy and clinical outcomes of open dorsal approach for managing Kaplan's dislocation (dorsal metacarpophalangeal joint dislocation) in patients with failed closed reduction. Methods: A prospective case series of 11 patients with Kaplan's dislocation was conducted at the Department of Orthopaedics, Gauhati Medical College and Hospital from 2022 to 2023. Patients aged 18-60 years with confirmed dorsal MCP joint dislocation requiring open reduction were included. An open dorsal approach with precise reduction and K-wire fixation was performed. Postoperative rehabilitation included ROM exercises. Clinical outcomes have been assessed by employing Visual Analog Scale (VAS) for pain and goniometric measurements for range of motion (ROM) at 6 and 12 weeks post-surgery. Results: All 11 patients achieved successful joint reduction and stabilization. Mean VAS scores improved from preoperative 7.72 ± 0.65 to 1.45 ± 0.69 at 12 weeks (p < 0.001). Total Active Motion (TAM) score at 12 weeks was 316.5° ± 32.8° with a mean recovery of 90.4% compared to the contralateral unaffected joint. Clinical outcomes were excellent in 8 patients (72.7%) and good in 3 patients (27.3%). No major complications were observed during follow-up. Conclusion: The open dorsal approach for Kaplan's dislocation provides a reliable surgical technique for achieving anatomical reduction and stable joint fixation. This approach minimizes complications associated with repeated closed reduction attempts and facilitates early functional recovery, making it a viable surgical option for managing these complex injuries.