Proximal interphalangeal dislocation (finger)

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

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

Hand and finger dislocations

Hand and finger injuries

Evaluation

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 [2]

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

  • 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

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