Joseph A. Rosenbaum
Hisham M. Awan
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.
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.
Volar dislocations—the middle phalanx (P2) is dislocated volarly relative to the proximal phalanx (P1).
Relatively rare injuries
Dorsal dislocations—P2 is dislocated dorsally relative to P1.
More common than volar
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.
Radiographs (order finger radiograph; order hand radiograph if additional injuries suspected)
PIP joint dorsal simple dislocations
Volar plate may be avulsed, usually from distal insertion.
Acute injuries can generally be treated nonsurgically.
Reduction maneuver—hyperextension, axial traction, and flexion
Volar plate does not typically get entrapped.
Ensure concentric reduction on perfect lateral postreduction radiograph.
Place into extension-blocking splint in slight flexion for 1 to 2 weeks.
Transition to buddy taping and range of motion (ROM) exercises thereafter.
Chronic injuries—may present with swan neck deformity or PIP hyperextension
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