Phalanx Dislocations



Phalanx Dislocations


Joseph A. Rosenbaum

Hisham M. Awan



INTRODUCTION



  • 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


EVALUATION



  • 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


ACUTE MANAGEMENT



  • 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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