eMedicine Specialties > Emergency Medicine > Trauma & Orthopedics

Dislocation, Interphalangeal

Author: Grace M Young, MD, Associate Professor, Department of Pediatrics, University of Maryland Medical Center
Contributor Information and Disclosures

Updated: Feb 29, 2008

Introduction

Background

Interphalangeal (IP) joint dislocations of the fingers and toes are common. Typically associated with forced hyperextension or hyperflexion of the digit, they require immediate reduction. The IP joint is a hinge joint that allows only flexion and extension and consists of several ligamentous complexes. The volar plate provides stability against hyperextension injury and dorsal dislocation of the phalanx. It often ruptures during a dorsal dislocation and may be associated with an avulsion fracture at the base of the phalanx. The strong collateral ligament complex resists hyperextension and lateral dislocation injury. The extensor hood complex stabilizes against hyperflexion injury and volar displacement of the phalanx.

Pathophysiology

Forced hyperextension with axial compression causes a dorsal dislocation of the proximal IP (PIP) or distal IP (DIP) joint, in which the middle (or distal) phalanx is dislocated dorsal to the proximal (middle) phalanx. Forced hyperflexion results in a volar IP joint dislocation (eg, where the distal phalanx is dislocated volar to the middle phalanx).

Patients whose digits have neurovascular compromise, an open joint dislocation, ligamentous or volar plate rupture, joint instability, or an associated fracture should have immediate orthopedic consultation. All finger dislocations should be reevaluated subsequently by an orthopedic or hand specialist to manage potential subtle ligamentous, cartilaginous, or bony injury. A lateral or volar PIP joint dislocation, although rare, requires an orthopedist for possible open reduction with internal fixation. A dislocation of the metacarpophalangeal (MCP) joint, although rare in adults, may be more common in children. MCP dislocation usually requires open reduction by a pediatric orthopedist.

Frequency

United States

Dorsal PIP dislocation is the most common IP dislocation. Volar IP joint dislocations are relatively uncommon. PIP joint dislocations occur more frequently than DIP joint dislocations.

Clinical

History

  • History usually reveals a traumatic athletic injury or entrapment of the finger between objects. Typically, the finger was jammed or bent backwards during basketball, football, or other sports activity. The patient often experiences diffuse pain, swelling, and tingling.
  • Determine the following aspects of the patient's history:
    • Which is the dominant hand of the patient and which hand is injured?
    • What is the patient's occupation?
    • Where did injury occur (eg, job, assault)?
    • How much time has passed since the initial injury?

Physical

  • An accurate and detailed examination often requires digital block anesthesia. The clinician should test and document each of the following:
    • Gross deformity, diffuse edema, ecchymosis, and tenderness of the involved digit
    • Possible anesthesia or paresthesia in the distal aspect of the involved digit
    • Range of motion, function, and stability of involved joint
    • Detailed neurovascular examination of entire involved hand
  • Restriction in active flexion and extension, especially against resistance, suggests tendinous or ligamentous rupture or intraarticular osteochondral fragment.
    • Test the integrity of the volar plate by passive hyperextension
    • Test the collateral ligaments by exerting radial and ulnar stress.
  • Skin laceration after a blunt hyperextension injury suggests volar plate rupture.

Causes

  • Axial compression or lateral forces directed to the digit
  • Forced hyperextension or hyperflexion of digit from traumatic athletic injury, entrapment of finger between objects, or a fall
  • Predisposition to ligamentous injury possible in those with lax ligaments (eg, Down syndrome)

More on Dislocation, Interphalangeal

Overview: Dislocation, Interphalangeal
Differential Diagnoses & Workup: Dislocation, Interphalangeal
Treatment & Medication: Dislocation, Interphalangeal
Follow-up: Dislocation, Interphalangeal
Multimedia: Dislocation, Interphalangeal
References
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References

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  11. Otani K, Fukuda K, Hamanishi C. An unusual dorsal fracture-dislocation of the proximal interphalangeal joint. J Hand Surg Eur Vol. Apr 2007;32(2):193-4. [Medline].

  12. Papadonikolakis A, Li Z, Smith BP, Koman LA. Fractures of the phalanges and interphalangeal joints in children. Hand Clin. Feb 2006;22(1):11-8. [Medline].

  13. Van Ransbeeck H, De Smet L. Double dislocation of both interphalangeal joints in the finger. Case report and literature review. Acta Orthop Belg. Feb 2004;70(1):72-5. [Medline].

  14. Wang QC, Johnson BA. Fingertip injuries. Am Fam Physician. May 15 2001;63(10):1961-6. [Medline].

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Further Reading

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Keywords

IP, finger, toe, proximal interphalangeal joint, PIP, distal interphalangeal joint, DIP, IP joint dislocations, interphalangeal joint dislocations, interphalangeal dislocations, toe dislocation, finger dislocation, dorsal PIP dislocation, volar IP dislocation, IP joint, PIP joint dislocations, DIP joint dislocations, thumb dislocation

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Contributor Information and Disclosures

Author

Grace M Young, MD, Associate Professor, Department of Pediatrics, University of Maryland Medical Center
Grace M Young, MD is a member of the following medical societies: American Academy of Pediatrics and American College of Emergency Physicians
Disclosure: Nothing to disclose.

Medical Editor

James E Keany, MD, FACEP, Medical Director, JetWest International Air Ambulance; Consulting Staff, Department of Emergency Services, Mission Hospital Regional Medical Center; Host of Healthbuzz at Jim.MD
James E Keany, MD, FACEP is a member of the following medical societies: American College of Emergency Physicians, American College of Sports Medicine, and California Medical Association
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Tom Scaletta, MD, President, Emergency Excellence (EmEx) (www.emergencyexcellence.com); Assistant Professor of Emergency Medicine, Rush Medical College, Cook County Hospital; Chairperson, Department of Emergency Medicine, Edward Hospital; Past-President, American Academy of Emergency Medicine
Tom Scaletta, MD is a member of the following medical societies: American Academy of Emergency Medicine and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

CME Editor

John D Halamka, MD, MS, Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center
John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine
Disclosure: Nothing to disclose.

Chief Editor

Rick Kulkarni, MD, Medical Director, Assistant Professor of Surgery, Section of Emergency Medicine, Yale-New Haven Hospital
Rick Kulkarni, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Emergency Medicine, American College of Emergency Physicians, American Medical Association, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine
Disclosure: WebMD Salary Employment

 
 
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