Phalanx Dislocations

Phalanx Dislocations

Joseph A. Rosenbaum

Hisham M. Awan


  • Pathoanatomy

    • Dislocations of the finger joints secondary to trauma

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

  • Mechanism of injury

    • 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.

  • Epidemiology/background

    • 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


  • History

    • 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.

  • Physical examination

    • 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).

  • Imaging/assessment

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

    • Identify any fractures if present.

  • Classification

    • 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

      • Volar dislocations—the middle phalanx (P2) is dislocated volarly relative to the proximal phalanx (P1).

        • Relatively rare injuries

      • Lateral dislocations

      • Dorsal dislocations—P2 is dislocated dorsally relative to P1.

        • More common than volar

      • Volar fracture-dislocation

      • Dorsal fracture-dislocation

    • DIP dislocations

      • Dorsal dislocations, lateral dislocations

      • Analogous to thumb interphalangeal (IP) joint in anatomical terms


  • Emergency room management

    • 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)

May 7, 2019 | Posted by in ORTHOPEDIC | Comments Off on Phalanx Dislocations
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