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Metacarpophalangeal joint arthroscopy in the fingers other than the thumb: Retrospective comparison of horizontal versus vertical traction
Available online at
ScienceDirect www.sciencedirect.com Chirurgie de la main 34 (2015) 105–108
Surgical technique
Metacarpophalangeal joint arthroscopy in the fingers other than the thumb: Retrospective comparison of horizontal versus vertical traction Arthroscopie des articulations métacarpo-phalangiennes des doigts longs : étude rétrospective comparant traction horizontale versus verticale J.J. Hidalgo-Díaz a, S. Ichihara b, C. Taleb a, S. Gouzou a, S. Facca a, I. Naroura a, F. Bodin c, P. Liverneaux a,* a
Icube CNRS 7357, FMTS, service de chirurgie de la main, SOS main, CCOM, hôpitaux universitaires de Strasbourg, université de Strasbourg, 10, avenue Baumann, 67400 Illkirch, France b Department of orthopaedic surgery, Juntendo university hospital, Tokyo, Japan c Department of plastic surgery, FMTS, university hospital of Strasbourg, university of Strasbourg, 67000 Strasbourg, France Received 4 December 2014; received in revised form 8 February 2015; accepted 10 February 2015 Available online 7 May 2015
Abstract The goal of this study was to compare the advantages and disadvantages of horizontal versus vertical traction by reviewing a small series of metacarpophalangeal (MCP) joint arthroscopy in the fingers other than the thumb. Our series included eight patients operated with traction placed along the axis of the operated finger. In four cases, traction was applied horizontally and in the other four, it was applied vertically. Arthroscopy was performed using dorsomedial and dorsoradial portals. The fluoroscopy unit was placed either vertically or horizontally as required. The average duration of patient set-up was 17.75 min in the horizontal traction group and 32 min in the vertical traction group. The average tourniquet time was 56.75 min in the horizontal traction group and 71 min in the vertical traction group. Horizontal traction required an additional procedure that can potentially compromise surgical asepsis. Vertical traction was less comfortable for the surgeon and horizontal placement of the fluoroscope increased the risk of compromised asepsis. Overall, arthroscopy of the MCP joint of the fingers other than the thumb is an easy technique, indicated for trauma-related and chronic lesions, which may be best performed with horizontal traction. # 2015 Elsevier Masson SAS. All rights reserved. Keywords: Metacarpophalangeal joint; Arthroscopy; Joint lesions
Résumé Le but de ce travail était de comparer les avantages et les inconvénients de la traction horizontale et de la traction verticale sur une série clinique de 8 cas d’arthroscopie de l’articulation métacarpo-phalangienne (MCP) des doigts longs. Notre série comprenait 8 patients opérés sous traction dans l’axe du doigt à opérer. Dans 4 cas, la traction était horizontale et dans 4 cas la traction était verticale. L’arthroscopie était réalisée alternativement par 2 voies dorso-médiale et dorso-radiale. Le cas échéant, le fluoroscope était installé verticalement ou horizontalement. La durée moyenne de l’installation était de 17,75 min dans le groupe traction horizontale et 32 min dans le groupe traction verticale. La durée moyenne du garrot était 56,75 min dans le groupe traction horizontale et 71 min dans le groupe traction verticale. La traction horizontale nécessitait une geste qui comportait un risque de faute d’asepsie. La traction verticale était moins confortable et la position horizontale de l’amplificateur de brillance augmentait les risques de faute d’asepsie. Au total, l’arthroscopie des MCP des doigts longs est une technique facile, indiquée dans des lésions traumatiques ou chroniques, qui peut être réalisée au mieux sous traction horizontale. # 2015 Elsevier Masson SAS. Tous droits réservés. Mots clés : Articulation métacarpo-phalangienne ; Arthroscopie ; Lésions articulaires
* Corresponding author. E-mail address: [email protected] (P. Liverneaux). http://dx.doi.org/10.1016/j.main.2015.02.003 1297-3203/# 2015 Elsevier Masson SAS. All rights reserved.
J.J. Hidalgo-Díaz et al. / Chirurgie de la main 34 (2015) 105–108
106
1. Introduction
2. Materials and methods
Metacarpophalangeal (MCP) joint arthroscopy was first described in 1979 [1]. Since then, a large number of publications have appeared dealing with thumb MCP joint arthroscopy [2]. On the other hand, only a few publications have featured the four other fingers, and only four of them included small clinical series [3–6]. Indications were either diagnostic procedures such as cartilage assessment [3] or synovial biopsy [7], or therapeutic procedures such as synovectomy [4,5,8], fracture fixation [6], and osteochondritis perforation [6]. Almost every study describes the use of vertical traction, except for one where no traction was applied [4]. The goal of this study was to compare the advantages and disadvantages of horizontal versus vertical traction in a small clinical series of MCP joint arthroscopy of the fingers (excluding the thumb).
Every case of finger MCP joint arthroscopy carried out by five different surgeons between November 2013 and November 2014 was retrospectively included in the series. Thumb arthroscopy cases were excluded. Our series included eight patients with an average age of 31 years (from 16 to 48); all of them were male. The right hand was affected in six patients (Table 1). Every patient was operated under regional anesthesia with a tourniquet. Chinese finger traps were used to apply traction along the axis of the finger (Fig. 1). In four cases, the traction was applied horizontally in a LeibingerTM 0730950 system (Fig. 2). In the other four cases, the traction was applied vertically in a Whippel Tower (Fig. 3). In all cases, the arthroscopy technique consisted of two-portal access to the MCP joint, one of them dorso-ulnar and the other, dorsoradial.
Table 1 Characteristics for the series of 8 patients operated by long finger MCP arthroscopy. Patient (No.)
Gender (M/F)
Age (years)
Profession (M/S)
Dominant hand (R/L)
Affected side (R/L)
Affected finger (2–5)
Diagnosis
1 2 3 4 5 6 7 8
M M M M M M M M
34 21 41 16 17 28 48 44
M S M S S S S M
R R R R R R R R
R R L R R R L R
2 2 3 5 2 3 4 2
Fracture Fracture Locked finger Fracture Osteochondritis Fracture Fracture Fracture
F: female; L: left; M: male; M: manual worker; S: sedentary worker; R: right.
Fig. 1. Traction systems for finger MCP joint arthroscopy. Horizontal traction (screwed to the table) (A). Vertical traction (placed on the table) (B).
J.J. Hidalgo-Díaz et al. / Chirurgie de la main 34 (2015) 105–108
Fig. 2. Set-up for finger MCP arthroscopy using horizontal traction. Shaver from StortzTM (Tuttlingen, Germany).
107
Both portals were used alternately for a 1.9 mm scope and for instrumentation (StortzTM, Tuttlingen, Germany). In trauma cases, a fluoroscopy unit (XiScan44001, FM controlTM, Alava, Spain) was used to take anterior-posterior (AP) and lateral views of the MCP joint before or after the arthroscopy. The fluoroscope was installed vertically in the horizontal traction cases and horizontally in the vertical traction cases. Results were determined by collecting quantitative (set-up problems, technical difficulties) and qualitative information about the procedure with the two traction systems. Patient setup problems were quantitatively studied by measuring the time in minutes from the beginning of skin-swabbing to tourniquet inflating. This time included skin-swabbing, set-up of sterile drapes and installation of the traction system. As the skinswabbing and sterile drape set-up time is theoretically consistent, only the traction system installation times were expected to vary. Technical difficulties were quantitatively evaluated by measuring the tourniquet time in minutes. Information about incidents was gathered by researching undesirable events. No statistical analysis was performed because of the small sample size
3. Results
Fig. 3. Set-up for finger MCP arthroscopy using vertical traction. Shaver from StortzTM (Tuttlingen, Germany).
The results are shown in Table 2. The average patient set-up time was 17.75 minutes in the horizontal traction group and 32 minutes in the vertical traction group. The average tourniquet time was 56.75 minutes in the horizontal traction group and 71 minutes in the vertical traction group. Qualitatively, fixation of the horizontal traction system was found to require a screwing maneuver that places the surgeon’s hand under the table; this is could potentially compromise surgical asepsis. The ergonomics of the vertical traction system not only required the surgeon’s arms to be held in an uncomfortable, tiresome vertical position, but also did not allow the surgeon’s forearms to be stable, which is necessary for precise manipulations. Also, the ergonomics of the horizontal fluoroscope position used in the vertical traction group decreased the surgeon’s working space, and also increased the risks of compromised asepsis. We had no objective way to determine whether the intra-articular exposure was different in the horizontal or vertical traction configuration. In particular,
Table 2 Results for the series of 8 patients operated by long finger MCP arthroscopy. Patient (No.)
Traction (H/V)
Technique (S/T/O/R)
Set-up time (min)
Tourniquet time (min)
1 2 3 4 5 6 7 8
V V V H V H H H
T S S T O R T T
10 79 13 8 27 21 13 29
83 64 113 45 25 65 72 45
H: horizontal; O: osteochondritis; R: resection of osteophyte or intra-articular malunion; S: synovectomy; T: traumatology; V: vertical.
108
J.J. Hidalgo-Díaz et al. / Chirurgie de la main 34 (2015) 105–108
the most volar part of the joint was equally difficult to access in both cases. 4. Discussion The technique used for arthroscopy of the MCP joint differs for the thumb versus the other fingers. All publications describe a similar technique. The classic configuration for MCP joint arthroscopy of the fingers requires that 2.3–5.0 kg of vertical traction be applied [1,2,5,6,9–13]. In one study, no traction system was used because the authors believe that it damages the skin and has little use because of the MCP joint’s anatomy [4]. Like other groups, we use a small joint arthroscope that is 1.6 to 1.9 mm in diameter [4,6,9–12]. We have described our experience with performing MCP arthroscopy with horizontal or vertical traction. However, the small number of cases made it impossible to carry out a statistical analysis and the variation in the surgical techniques used would cause a statistical bias. Nevertheless, some conclusions can be drawn. Horizontal traction had more advantages and fewer disadvantages than vertical traction. The set-up time and the tourniquet time were shorter. The ergonomics were better, not only for the surgeon – whose forearms could lay comfortably on the hand table in the horizontal position – but also for the fluoroscope, which was less of an obstruction and easier to handle. Regarding surgical asepsis, both configurations could be potentially compromising: while setting up the horizontal traction system and while manipulating the fluoroscope in the vertical traction cases. Horizontal traction seems to be better than vertical traction. Of course, it is a matter of habit, and some surgeons prefer using vertical traction. The indications in our series were similar to those in other studies on this topic: four metacarpal head or proximal phalanx base fracture fixations, one arthrolysis with malunion resection from metacarpal head, one metacarpal head osteochondritis and two joint synovectomies. Fluoroscopy is used mainly in trauma cases. In our cases, fluoroscopy was used in both types of cases: it was used after arthroscopy in non-trauma cases to check the quality of a bone resection procedure; it was used before arthroscopy in trauma cases to check the quality of reduction when performing fracture fixation. In trauma cases, traction helps to reduce the fracture by ligamentotaxis and makes fracture fixation easier to achieve. In terms of the contraindications, only skin infection in the area of the portals has been specified [9,10]. Therefore, there is no real contraindication for this easy technique because of the simple anatomy of the MCP joint of the fingers (except the thumb). The risk of tendon rupture is the most feared complication [4–6]. But actually only one case of delayed flexor pollicis
longus rupture has been reported, presumably due to overzealous use of a radiofrequency probe [13]. Since the extensor tendon is also located extremely close to the portals, extra caution should be taken to avoid any inadvertent damage.
5. Conclusion Overall, MCP arthroscopy of the fingers other than the thumb is an easy technique, indicated in trauma-related or chronic lesions, which may be best performed with horizontal traction.
Disclosure of interest Philippe Liverneaux has conflicts of interest with Newclip Technics, Integra, Argomedical, iiN medical. The other authors declare that they have no conflicts of interest concerning this article.
References [1] Chen YC. Arthroscopy of the wrist and finger joints. Orthop Clin North Am 1979;10:723–33. [2] Slade 3rd JF, Gutow AP. Arthroscopy of the metacarpophalangeal joint. Hand Clin 1999;15:501–27. [3] Ostendorf B, Peters R, Dann P, Becker A, Scherer A, Wedekind F, et al. Magnetic resonance imaging and miniarthroscopy of metacarpophalangeal joints: sensitive detection of morphologic changes in rheumatoid arthritis. Arthritis Rheum 2001;44:2492–502. [4] Sekiya I, Kobayashi M, Okamoto H, Iguchi H, Waguri-Nagaya Y, Goto H, Nozaki M, et al. Arthroscopic synovectomy of the metacarpophalangeal and proximal interphalangeal joints. Tech Hand Up Extrem Surg 2008;12:221–5. [5] Wei N, Delauter SK, Erlichman MS, Rozmaryn LM, Beard SJ, Henry DL. Arthroscopic synovectomy of the metacarpophalangeal joint in refractory rheumatoid arthritis: a technique. Arthroscopy 1999;15:265–8. [6] Erdos J, Gannon C, Baratz ME. Arthroscopy of the metacarpophalangeal joint. Oper Tech Orthop 2007;17:133–9. [7] Gáspár L, Szekanecz Z, Dezso B, Szegedi G, Csernátony Z, Szepesi K. Technique of synovial biopsy of metacarpophalangeal joints using the needle arthroscope. Knee Surg Sports Traumatol Arthrosc 2003;11:50–2. [8] Wall LB, Goldfarb CA. Metacarpophalangeal joint arthroscopy: outcomes for the painful, radiographically normal joint. J Hand Surg 2014;39:887–8. [9] Berner SH. Metacarpophalangeal joint arthroscopy-techniques and applications. Tech Hand Up Extrem Surg 2008;12:208–15. [10] Badia A. Arthroscopy of the trapeziometacarpal and metacarpophalangeal joints. Chir Main 2006;25S1:S259–70. [11] Cobb TK, Berner SH, Badía A. New frontiers in hand arthroscopy. Hand Clin 2011;27:383–94. [12] Kodama A, Itotani Y, Mizuseki T. Arthroscopic reduction of complex dorsal metacarpophalangeal dislocation of index finger. Arthrosc Tech 2014;3:e261–4. [13] Choi AK, Chow EC, Ho PC, Chow YY. Metacarpophalangeal joint arthroscopy: indications revisited. Hand Clin 2011;27:369–82.
ScienceDirect www.sciencedirect.com Chirurgie de la main 34 (2015) 105–108
Surgical technique
Metacarpophalangeal joint arthroscopy in the fingers other than the thumb: Retrospective comparison of horizontal versus vertical traction Arthroscopie des articulations métacarpo-phalangiennes des doigts longs : étude rétrospective comparant traction horizontale versus verticale J.J. Hidalgo-Díaz a, S. Ichihara b, C. Taleb a, S. Gouzou a, S. Facca a, I. Naroura a, F. Bodin c, P. Liverneaux a,* a
Icube CNRS 7357, FMTS, service de chirurgie de la main, SOS main, CCOM, hôpitaux universitaires de Strasbourg, université de Strasbourg, 10, avenue Baumann, 67400 Illkirch, France b Department of orthopaedic surgery, Juntendo university hospital, Tokyo, Japan c Department of plastic surgery, FMTS, university hospital of Strasbourg, university of Strasbourg, 67000 Strasbourg, France Received 4 December 2014; received in revised form 8 February 2015; accepted 10 February 2015 Available online 7 May 2015
Abstract The goal of this study was to compare the advantages and disadvantages of horizontal versus vertical traction by reviewing a small series of metacarpophalangeal (MCP) joint arthroscopy in the fingers other than the thumb. Our series included eight patients operated with traction placed along the axis of the operated finger. In four cases, traction was applied horizontally and in the other four, it was applied vertically. Arthroscopy was performed using dorsomedial and dorsoradial portals. The fluoroscopy unit was placed either vertically or horizontally as required. The average duration of patient set-up was 17.75 min in the horizontal traction group and 32 min in the vertical traction group. The average tourniquet time was 56.75 min in the horizontal traction group and 71 min in the vertical traction group. Horizontal traction required an additional procedure that can potentially compromise surgical asepsis. Vertical traction was less comfortable for the surgeon and horizontal placement of the fluoroscope increased the risk of compromised asepsis. Overall, arthroscopy of the MCP joint of the fingers other than the thumb is an easy technique, indicated for trauma-related and chronic lesions, which may be best performed with horizontal traction. # 2015 Elsevier Masson SAS. All rights reserved. Keywords: Metacarpophalangeal joint; Arthroscopy; Joint lesions
Résumé Le but de ce travail était de comparer les avantages et les inconvénients de la traction horizontale et de la traction verticale sur une série clinique de 8 cas d’arthroscopie de l’articulation métacarpo-phalangienne (MCP) des doigts longs. Notre série comprenait 8 patients opérés sous traction dans l’axe du doigt à opérer. Dans 4 cas, la traction était horizontale et dans 4 cas la traction était verticale. L’arthroscopie était réalisée alternativement par 2 voies dorso-médiale et dorso-radiale. Le cas échéant, le fluoroscope était installé verticalement ou horizontalement. La durée moyenne de l’installation était de 17,75 min dans le groupe traction horizontale et 32 min dans le groupe traction verticale. La durée moyenne du garrot était 56,75 min dans le groupe traction horizontale et 71 min dans le groupe traction verticale. La traction horizontale nécessitait une geste qui comportait un risque de faute d’asepsie. La traction verticale était moins confortable et la position horizontale de l’amplificateur de brillance augmentait les risques de faute d’asepsie. Au total, l’arthroscopie des MCP des doigts longs est une technique facile, indiquée dans des lésions traumatiques ou chroniques, qui peut être réalisée au mieux sous traction horizontale. # 2015 Elsevier Masson SAS. Tous droits réservés. Mots clés : Articulation métacarpo-phalangienne ; Arthroscopie ; Lésions articulaires
* Corresponding author. E-mail address: [email protected] (P. Liverneaux). http://dx.doi.org/10.1016/j.main.2015.02.003 1297-3203/# 2015 Elsevier Masson SAS. All rights reserved.
J.J. Hidalgo-Díaz et al. / Chirurgie de la main 34 (2015) 105–108
106
1. Introduction
2. Materials and methods
Metacarpophalangeal (MCP) joint arthroscopy was first described in 1979 [1]. Since then, a large number of publications have appeared dealing with thumb MCP joint arthroscopy [2]. On the other hand, only a few publications have featured the four other fingers, and only four of them included small clinical series [3–6]. Indications were either diagnostic procedures such as cartilage assessment [3] or synovial biopsy [7], or therapeutic procedures such as synovectomy [4,5,8], fracture fixation [6], and osteochondritis perforation [6]. Almost every study describes the use of vertical traction, except for one where no traction was applied [4]. The goal of this study was to compare the advantages and disadvantages of horizontal versus vertical traction in a small clinical series of MCP joint arthroscopy of the fingers (excluding the thumb).
Every case of finger MCP joint arthroscopy carried out by five different surgeons between November 2013 and November 2014 was retrospectively included in the series. Thumb arthroscopy cases were excluded. Our series included eight patients with an average age of 31 years (from 16 to 48); all of them were male. The right hand was affected in six patients (Table 1). Every patient was operated under regional anesthesia with a tourniquet. Chinese finger traps were used to apply traction along the axis of the finger (Fig. 1). In four cases, the traction was applied horizontally in a LeibingerTM 0730950 system (Fig. 2). In the other four cases, the traction was applied vertically in a Whippel Tower (Fig. 3). In all cases, the arthroscopy technique consisted of two-portal access to the MCP joint, one of them dorso-ulnar and the other, dorsoradial.
Table 1 Characteristics for the series of 8 patients operated by long finger MCP arthroscopy. Patient (No.)
Gender (M/F)
Age (years)
Profession (M/S)
Dominant hand (R/L)
Affected side (R/L)
Affected finger (2–5)
Diagnosis
1 2 3 4 5 6 7 8
M M M M M M M M
34 21 41 16 17 28 48 44
M S M S S S S M
R R R R R R R R
R R L R R R L R
2 2 3 5 2 3 4 2
Fracture Fracture Locked finger Fracture Osteochondritis Fracture Fracture Fracture
F: female; L: left; M: male; M: manual worker; S: sedentary worker; R: right.
Fig. 1. Traction systems for finger MCP joint arthroscopy. Horizontal traction (screwed to the table) (A). Vertical traction (placed on the table) (B).
J.J. Hidalgo-Díaz et al. / Chirurgie de la main 34 (2015) 105–108
Fig. 2. Set-up for finger MCP arthroscopy using horizontal traction. Shaver from StortzTM (Tuttlingen, Germany).
107
Both portals were used alternately for a 1.9 mm scope and for instrumentation (StortzTM, Tuttlingen, Germany). In trauma cases, a fluoroscopy unit (XiScan44001, FM controlTM, Alava, Spain) was used to take anterior-posterior (AP) and lateral views of the MCP joint before or after the arthroscopy. The fluoroscope was installed vertically in the horizontal traction cases and horizontally in the vertical traction cases. Results were determined by collecting quantitative (set-up problems, technical difficulties) and qualitative information about the procedure with the two traction systems. Patient setup problems were quantitatively studied by measuring the time in minutes from the beginning of skin-swabbing to tourniquet inflating. This time included skin-swabbing, set-up of sterile drapes and installation of the traction system. As the skinswabbing and sterile drape set-up time is theoretically consistent, only the traction system installation times were expected to vary. Technical difficulties were quantitatively evaluated by measuring the tourniquet time in minutes. Information about incidents was gathered by researching undesirable events. No statistical analysis was performed because of the small sample size
3. Results
Fig. 3. Set-up for finger MCP arthroscopy using vertical traction. Shaver from StortzTM (Tuttlingen, Germany).
The results are shown in Table 2. The average patient set-up time was 17.75 minutes in the horizontal traction group and 32 minutes in the vertical traction group. The average tourniquet time was 56.75 minutes in the horizontal traction group and 71 minutes in the vertical traction group. Qualitatively, fixation of the horizontal traction system was found to require a screwing maneuver that places the surgeon’s hand under the table; this is could potentially compromise surgical asepsis. The ergonomics of the vertical traction system not only required the surgeon’s arms to be held in an uncomfortable, tiresome vertical position, but also did not allow the surgeon’s forearms to be stable, which is necessary for precise manipulations. Also, the ergonomics of the horizontal fluoroscope position used in the vertical traction group decreased the surgeon’s working space, and also increased the risks of compromised asepsis. We had no objective way to determine whether the intra-articular exposure was different in the horizontal or vertical traction configuration. In particular,
Table 2 Results for the series of 8 patients operated by long finger MCP arthroscopy. Patient (No.)
Traction (H/V)
Technique (S/T/O/R)
Set-up time (min)
Tourniquet time (min)
1 2 3 4 5 6 7 8
V V V H V H H H
T S S T O R T T
10 79 13 8 27 21 13 29
83 64 113 45 25 65 72 45
H: horizontal; O: osteochondritis; R: resection of osteophyte or intra-articular malunion; S: synovectomy; T: traumatology; V: vertical.
108
J.J. Hidalgo-Díaz et al. / Chirurgie de la main 34 (2015) 105–108
the most volar part of the joint was equally difficult to access in both cases. 4. Discussion The technique used for arthroscopy of the MCP joint differs for the thumb versus the other fingers. All publications describe a similar technique. The classic configuration for MCP joint arthroscopy of the fingers requires that 2.3–5.0 kg of vertical traction be applied [1,2,5,6,9–13]. In one study, no traction system was used because the authors believe that it damages the skin and has little use because of the MCP joint’s anatomy [4]. Like other groups, we use a small joint arthroscope that is 1.6 to 1.9 mm in diameter [4,6,9–12]. We have described our experience with performing MCP arthroscopy with horizontal or vertical traction. However, the small number of cases made it impossible to carry out a statistical analysis and the variation in the surgical techniques used would cause a statistical bias. Nevertheless, some conclusions can be drawn. Horizontal traction had more advantages and fewer disadvantages than vertical traction. The set-up time and the tourniquet time were shorter. The ergonomics were better, not only for the surgeon – whose forearms could lay comfortably on the hand table in the horizontal position – but also for the fluoroscope, which was less of an obstruction and easier to handle. Regarding surgical asepsis, both configurations could be potentially compromising: while setting up the horizontal traction system and while manipulating the fluoroscope in the vertical traction cases. Horizontal traction seems to be better than vertical traction. Of course, it is a matter of habit, and some surgeons prefer using vertical traction. The indications in our series were similar to those in other studies on this topic: four metacarpal head or proximal phalanx base fracture fixations, one arthrolysis with malunion resection from metacarpal head, one metacarpal head osteochondritis and two joint synovectomies. Fluoroscopy is used mainly in trauma cases. In our cases, fluoroscopy was used in both types of cases: it was used after arthroscopy in non-trauma cases to check the quality of a bone resection procedure; it was used before arthroscopy in trauma cases to check the quality of reduction when performing fracture fixation. In trauma cases, traction helps to reduce the fracture by ligamentotaxis and makes fracture fixation easier to achieve. In terms of the contraindications, only skin infection in the area of the portals has been specified [9,10]. Therefore, there is no real contraindication for this easy technique because of the simple anatomy of the MCP joint of the fingers (except the thumb). The risk of tendon rupture is the most feared complication [4–6]. But actually only one case of delayed flexor pollicis
longus rupture has been reported, presumably due to overzealous use of a radiofrequency probe [13]. Since the extensor tendon is also located extremely close to the portals, extra caution should be taken to avoid any inadvertent damage.
5. Conclusion Overall, MCP arthroscopy of the fingers other than the thumb is an easy technique, indicated in trauma-related or chronic lesions, which may be best performed with horizontal traction.
Disclosure of interest Philippe Liverneaux has conflicts of interest with Newclip Technics, Integra, Argomedical, iiN medical. The other authors declare that they have no conflicts of interest concerning this article.
References [1] Chen YC. Arthroscopy of the wrist and finger joints. Orthop Clin North Am 1979;10:723–33. [2] Slade 3rd JF, Gutow AP. Arthroscopy of the metacarpophalangeal joint. Hand Clin 1999;15:501–27. [3] Ostendorf B, Peters R, Dann P, Becker A, Scherer A, Wedekind F, et al. Magnetic resonance imaging and miniarthroscopy of metacarpophalangeal joints: sensitive detection of morphologic changes in rheumatoid arthritis. Arthritis Rheum 2001;44:2492–502. [4] Sekiya I, Kobayashi M, Okamoto H, Iguchi H, Waguri-Nagaya Y, Goto H, Nozaki M, et al. Arthroscopic synovectomy of the metacarpophalangeal and proximal interphalangeal joints. Tech Hand Up Extrem Surg 2008;12:221–5. [5] Wei N, Delauter SK, Erlichman MS, Rozmaryn LM, Beard SJ, Henry DL. Arthroscopic synovectomy of the metacarpophalangeal joint in refractory rheumatoid arthritis: a technique. Arthroscopy 1999;15:265–8. [6] Erdos J, Gannon C, Baratz ME. Arthroscopy of the metacarpophalangeal joint. Oper Tech Orthop 2007;17:133–9. [7] Gáspár L, Szekanecz Z, Dezso B, Szegedi G, Csernátony Z, Szepesi K. Technique of synovial biopsy of metacarpophalangeal joints using the needle arthroscope. Knee Surg Sports Traumatol Arthrosc 2003;11:50–2. [8] Wall LB, Goldfarb CA. Metacarpophalangeal joint arthroscopy: outcomes for the painful, radiographically normal joint. J Hand Surg 2014;39:887–8. [9] Berner SH. Metacarpophalangeal joint arthroscopy-techniques and applications. Tech Hand Up Extrem Surg 2008;12:208–15. [10] Badia A. Arthroscopy of the trapeziometacarpal and metacarpophalangeal joints. Chir Main 2006;25S1:S259–70. [11] Cobb TK, Berner SH, Badía A. New frontiers in hand arthroscopy. Hand Clin 2011;27:383–94. [12] Kodama A, Itotani Y, Mizuseki T. Arthroscopic reduction of complex dorsal metacarpophalangeal dislocation of index finger. Arthrosc Tech 2014;3:e261–4. [13] Choi AK, Chow EC, Ho PC, Chow YY. Metacarpophalangeal joint arthroscopy: indications revisited. Hand Clin 2011;27:369–82.