By William E. Sanders, MD

Although the dorsal approach to complex MP dislocation has been described, those who have not operated on this lesion before may benefit from a small additional observation. The volar plate can be so tightly displaced over the metacarpal head that it appears to be the articular cartridge of the metacarpal head. At times the proximal margin may be found, but at times it is not evident. An incision longitudinally through the volar plate allows it to separate as if opening a zipper. It will then slide to either side of the metacarpal head and allow reduction of the dislocation.