Distal interphalangeal dislocation (finger)

Background

  • Uncommon due to firm attachment of skin and subcutaneous tissue to underlying bone
  • Usually dorsal dislocation

Clinical Features

  • Finger pain/deformity at DIP joint

Differential Diagnosis

Distal Finger (Including Nail) Injury

Hand and finger dislocations

Evaluation

  • Finger x-ray (PA and lateral)
    • True lateral of only the finger instead of hand will help detect subtle avulsion fractures [1]

Management

Dorsal

  • 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

  • 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

Disposition

  • If closed dislocation and successfully reduced → Discharge with hand surgery follow-up
  • If open or unable to be reduced in ED → hand surgery consult, likely admission

See Also

References

  1. Horn A. Management of Common Dislocations. In: Roberts and Hedges' Clinical Procedures in Emergency Medicine. 6th ed. Philadelphia, PA: Elsevier; 2014.