Kaplan's Lesion Treated with Open Reduction by Dorsal Approach

Kaplan's lesion is a rare injury of the metacarpophalangeal joint, which commonly involving the index finger. It is also one of the complex dorsal dislocations of the hand. Proper identification is required to provide appropriate treatment. Though the lesion clinically appears small it is not amenable to closed reduction. Open reduction is the treatment of choice. Two approaches-volar & dorsal have been described. Volar approach is widely used & written about. However the risk to neurovascular bundle is high.

At Hassan institute of medical sciences we treated 5 patients with Kaplan's lesion surgically by using dorsal approach. Our Aim was to analyse the effectiveness, accessibility & ease of this approach in treating these lesions & also note the complications.

All patients underwent open reduction by dorsal approach and regained their pre-functional status by 8 weeks period without any neurovascular injury.

This approach definitely offers better advantage in visualising the volar plate & joint, relatively safe in preventing neurovascular injury & will also be able to fix the associated fractures with ease. The relative disadvantage of longitudinally splitting of the volar plate did not interfere in the healing or stability of the lesion.