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
Evaluation
- Finger x-ray (PA and lateral)
- True lateral of only the finger instead of hand will help detect subtle avulsion fractures [1]
Management
- Consider digital block for pain control
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
- Horn A. Management of Common Dislocations. In: Roberts and Hedges' Clinical Procedures in Emergency Medicine. 6th ed. Philadelphia, PA: Elsevier; 2014.
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