Proximal interphalangeal dislocation (finger): Difference between revisions
Neil.m.young (talk | contribs) (Text replacement - "==Diagnosis==" to "==Evaluation==") |
|||
| (8 intermediate revisions by 2 users not shown) | |||
| Line 1: | Line 1: | ||
==Background== | ==Background== | ||
* | *Most common finger dislocation | ||
* | *Volar plate ruptures in both dorsal and volar PIP dislocations <ref name="Procedures for orthopedic emergencies">Davenport M. Procedures for orthopedic emergencies. In: Bond M, ed. Orthopedic Emergencies: Expert Management for the Emergency Physician. Cambridge: Cambridge University Press; October 31, 2013.</ref> | ||
*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== | ||
[[File:Dislocated Finger.jpg|thumb|Right fifth PIP phalanx dislocation]] | |||
*Mechanism: Due to axial load and hyperextension | |||
*Finger pain/deformity | |||
*Evaluate for extension into joint as open dislocations are common | |||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
{{Hand and finger dislocation types}} | {{Hand and finger dislocation types}} | ||
{{Hand and finger injury DDX}} | |||
==Evaluation== | ==Evaluation== | ||
[[File:Dislocated Finger XRay.png|thumb|PIP dislocation of right fifth phalanx]] | |||
*X-ray finger (PA and lateral) | |||
**True lateral of only the finger instead of hand will help detect subtle avulsion fractures <ref name="Management of Common Dislocations">Horn A. Management of Common Dislocations. In: Roberts and Hedges' Clinical Procedures in Emergency Medicine. 6th ed. Philadelphia, PA: Elsevier; 2014. </ref> | |||
==Management== | ==Management== | ||
| Line 15: | Line 24: | ||
===[[Splinting]]=== | ===[[Splinting]]=== | ||
*Stable | *Stable dorsal reduction: 3wk of immobilization in 20-30 deg of flexion | ||
**If volar dislocation, may have injury to central slip of the extensor tendons, so must be splinted in full extension for 3 weeks to prevent [[Boutonniere deformity]] | |||
*Unstable reduction: Surgery | *Unstable reduction: Surgery | ||
**Displacement occurs during active range of motion | **Displacement occurs during active range of motion or passive stressing of joint | ||
**>20 deg of deformity and instability with lateral testing | **>20 deg of deformity and instability with lateral testing | ||
==Disposition== | ==Disposition== | ||
*Outpatient | |||
**If reduced, with follow up within two weeks with hand specialist | |||
==See Also== | ==See Also== | ||
Revision as of 18:05, 28 April 2017
Background
- Most common finger dislocation
- Volar plate ruptures in both dorsal and volar PIP dislocations [1]
- 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
- Evaluate for extension into joint as open dislocations are common
Differential Diagnosis
Hand and finger dislocations
- Finger dislocations
- Thumb dislocations
- Hand dislocations
Hand and finger injuries
- Distal finger
- Other finger/thumb
- Boutonniere deformity
- Mallet finger
- Jammed finger
- Jersey finger
- Trigger finger
- Ring avulsion injury
- De Quervain tenosynovitis
- Infiltrative tenosynovitis
- Metacarpophalangeal ulnar ligament rupture (Gamekeeper's thumb)
- Hand
- Wrist
- Drummer's wrist
- Ganglion cyst
- Lunotriquetral ligament instability
- Scaphoid fracture
- Extensor digitorum tenosynovitis
- Compressive neuropathy ("bracelet syndrome")
- Intersection syndrome
- Snapping Extensor Carpi Ulnaris
- Vaughn Jackson syndrome
- General
Evaluation
- X-ray finger (PA and lateral)
- True lateral of only the finger instead of hand will help detect subtle avulsion fractures [2]
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 dorsal reduction: 3wk of immobilization in 20-30 deg of flexion
- If volar dislocation, may have injury to central slip of the extensor tendons, so must be splinted in full extension for 3 weeks to prevent Boutonniere deformity
- Unstable reduction: Surgery
- Displacement occurs during active range of motion or passive stressing of joint
- >20 deg of deformity and instability with lateral testing
Disposition
- Outpatient
- If reduced, with follow up within two weeks with hand specialist
See Also
External Links
References
- ↑ Davenport M. Procedures for orthopedic emergencies. In: Bond M, ed. Orthopedic Emergencies: Expert Management for the Emergency Physician. Cambridge: Cambridge University Press; October 31, 2013.
- ↑ Horn A. Management of Common Dislocations. In: Roberts and Hedges' Clinical Procedures in Emergency Medicine. 6th ed. Philadelphia, PA: Elsevier; 2014.