Dislocations of the finger joints secondary to trauma

Force applied to the joint exceeds the strength of its capsuloligamentous support.

Mechanisms of injury include torsional, angular, and tractional forces across joint.

Dislocation may be part of a more severe overall injury pattern including soft tissue injury to ligament, tendon, nerve, and/or vessels.

Dislocations of proximal interphalangeal (PIP) joints are more common than those of distal interphalangeal (DIP) dislocations.

PIP injuries are crucial to treat promptly and properly as the PIP joint is highly prone to stiffness once injured.

Common in laborers and athletes

Males > females

Typically caused by trauma, either direct or indirect

Presentation is often acute due to deformity and pain, but may be delayed—patients may initially dismiss injury.

May be overlooked initially in polytrauma cases.

Assess for edema, angular deformity, rotational deformity, quality of soft tissues.

Identify any lacerations, rule out open dislocation.

Assess sensation and capillary refill distally.

Assess the other digits as well as the hand and wrist.

Test for tendon function individually for each finger (flexor digitorum superficialis [FDS], flexor digitorum profundus, extensor digitorum communis).

Obtain finger radiograph initially if PIP joint or DIP joint dislocation is suspected.

Identify any fractures if present.

As with other dislocations, the nomenclature of direction of dislocation is based on which way the distal bone dislocates relative to the proximal bone.

PIP dislocations

DIP dislocations

Assess for other injuries.

Comfort measures—pain control, elevation, splinting (remove splints for radiograph)

Remove patient’s gloves, rings, and jewelry.

Elevation, ice

Radiographs (order finger radiograph; order hand radiograph if additional injuries suspected)

Representative image(s)