Proximal interphalangeal dislocation (finger): Difference between revisions
m (Rossdonaldson1 moved page Proximal interphalangeal (PIP) dislocation (finger) to Proximal interphalangeal dislocation (finger)) |
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==Background== | ==Background== | ||
*Also known as the PIP joint | *Also known as the PIP joint | ||
*Common | *Common | ||
*Dorsal dislocation occurs when volar plate ruptures | *Dorsal dislocation occurs when volar plate ruptures | ||
*Lateral dislocations occur when one of collateral ligaments ruptures with at least partial avulsion of volar plate from middle phalanx | *Lateral dislocations occur when one of collateral ligaments ruptures with at least partial avulsion of volar plate from middle phalanx | ||
==Clinical Features== | ==Clinical Features== | ||
*Mechanism: Due to axial load and hyperextension | |||
*Finger pain/deformity | |||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
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==Evaluation== | ==Evaluation== | ||
*X-ray finger (PA and lateral) | |||
==Management== | ==Management== | ||
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==Disposition== | ==Disposition== | ||
*Outpatient | |||
==See Also== | ==See Also== | ||
Revision as of 11:30, 16 October 2016
Background
- Also known as the PIP joint
- Common
- Dorsal dislocation occurs when volar plate ruptures
- Lateral dislocations occur when one of collateral ligaments ruptures with at least partial avulsion of volar plate from middle phalanx
Clinical Features
- Mechanism: Due to axial load and hyperextension
- Finger pain/deformity
Differential Diagnosis
Hand and finger dislocations
- Finger dislocations
- Thumb dislocations
- Hand dislocations
Evaluation
- X-ray finger (PA and lateral)
Management
- Consider digital block for pain control
Dorsal/Posterior
- Flex wrist, then hyperextend the joint
- Apply longitudinal traction followed by dorsal pressure to phalanx base
- Irreducible dislocation likely due to entrapment of avulsion fracture, profundus tendor or volar plate
- Without initial hyperextension, can be difficult to disengage from any trapped soft tissue
- Post reduction, look for central slip rupture, which may lead to Boutonniere deformity
Volar/Anterior
- Flex wrist then hyperflex the affected joint
- Apply gentle traction then extend the joint
- Often need open reduction due to volar plate entrapment
Splinting
- Stable Reduction: 3wk of immobilization in 20-30 deg of flexion
- Unstable reduction: Surgery
- Displacement occurs during active range of motion
- Displacement occurs during passive stressing of joint
- >20 deg of deformity and instability with lateral testing
Disposition
- Outpatient