Distal interphalangeal dislocation (finger)

Background

• Uncommon due to firm attachment of skin and subq tissue to underlying bone
  • When dislocations do occur usually are dorsal and are frequently open

Clinical Features

• Finger pain/deformity

Differential Diagnosis

Distal Finger (Including Nail) Injury

• Distal interphalangeal dislocation (finger)
• Distal phalanx (finger) fracture
• Finger amputation
• Fingertip avulsion
• Finger infection
• Nailbed laceration
• Nail avulsion
• Subungual hematoma

Hand and finger dislocations

• Finger dislocations
  • Distal interphalangeal dislocation (finger) (DIP)
  • Proximal interphalangeal dislocation (finger) (PIP)
  • Metacarpophalangeal dislocation (finger) (MCP)
• Thumb dislocations
  • Interphalangeal dislocation (thumb) (IP)
  • Metacarpophalangeal dislocation (thumb) (MCP)
• Hand dislocations
  • Carpometacarpal dislocation

Evaluation

• Finger x-ray (PA and lateral)
  • True lateral of only the finger instead of hand will help detect subtle avulsion fractures

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

• Splint in extension with dorsal splint x 3wk

Disposition

• Outpatient
  • If reduction successful, follow up within two weeks with hand specialist

See Also

• Hand and finger dislocations