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Distal interphalangeal dislocation (finger)
From WikEM
Contents
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
Hand and finger dislocations
- Finger dislocations
- Distal interphalangeal dislocation (finger) (DIP)
- Proximal interphalangeal dislocation (finger) (PIP)
- Metacarpophalangeal dislocation (finger) (MCP)
- Thumb dislocations
- Hand dislocations
Hand and finger injuries
- Radiograph positive
- Radiograph negative
- Dupeytren contracture
- Boutonniere deformity
- Hand and finger tendon injuries
- Ganglion cyst
- De Quervain tenosynovitis
- Intersection syndrome
- Drummer's wrist
- Extensor digitorum tenosynovitis
- Vaughn Jackson syndrome
- Snapping Extensor Carpi Ulnaris
- Compressive neuropathy, "bracelet syndrome"
- Scaphoid fracture
- Osteoarthritis
- Infiltrative tenosynovitis
- Gout
- Rheumatoid arthritis
- Trigger finger
- Mallet finger
- Jersey finger
- Jammed finger
- Subungual hematoma
- Fingertip laceration
- Metacarpophalangeal (MCP) ulnar ligament rupture (Gamekeeper's thumb)
- Nail avulsion
- High-pressure injection injury
Evaluation
- Finger x-ray (PA and lateral)
- True lateral of only the finger instead of hand will help detect subtle avulsion fractures [1]
Management
Reduction
- Dorsal
- Flex wrist
- Hyperextend the joint
- Apply longitudinal traction followed by dorsal pressure to phalanx base
- Irreducible cases 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
- Often need open reduction due to volar plate entrapment
- Flex wrist then hyperflex the affected joint
- Apply gentle traction then extend the joint
Splinting
- Splint in extension with dorsal splint x 3wk
Disposition
- Outpatient
- If reduction, follow up within two weeks with hand specialist
See Also
References
- ↑ Horn A. Management of Common Dislocations. In: Roberts and Hedges' Clinical Procedures in Emergency Medicine. 6th ed. Philadelphia, PA: Elsevier; 2014.