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Interphalangeal Dislocation Treatment & Management

  • Author: Grace M Young, MD; Chief Editor: Trevor John Mills, MD, MPH  more...
 
Updated: Nov 12, 2015
 

Prehospital Care

Splint, ice, and elevate the affected digit.[7, 8]  Evaluate neurovascular status before and after transport to the ED.

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Emergency Department Care

Reduction and postreduction procedures  (also see Joint Reduction, Finger Dislocation and Joint Reduction, Thumb Dislocation)[7, 8]

With the patient's hand or foot securely braced, grasp dislocated phalanx with dry gauze loosely wrapped around the phalanx (gauze improves grip). Hyperextend joint slightly with gentle longitudinal traction for a dorsal dislocation or hyperflex for a volar dislocation. Gradually push dislocated phalanx into its normal anatomical position.

Do not apply vigorous traction in a child, because that may interpose soft tissue or an osteochondral fragment into the distracted joint space and prevent reduction.

After reduction, examine the affected joint for flexor-extensor tendon function, active range of motion, localized tenderness, and instability in the medial-lateral and dorsal-volar directions.

Immobilize the joint with a foam-padded splint immediately after reduction to prevent redislocation or instability. Immobilize for 14-21 days for a PIP joint dislocation and 10-14 days for a DIP joint dislocation. Buddy taping for 3-6 weeks thereafter allows active range of motion and prevents hyperextension.

For a dorsal PIP dislocation, apply the splint dorsally with the joint in 20-30 degrees of flexion.

One study showed that management of PIP joint dislocations using controlled early mobilization with figure-of-eight splints provided greater range of motion and fewer hospital visits compared with other splinting techniques.[13]

For a volar DIP dislocation, apply the splint only to the DIP joint on the volar aspect; the DIP should be in full extension. Allow the PIP joint full range of motion.

In children, the cause of dislocation is more likely ligamentous laxity rather than rupture.[9, 10, 14] Immobilization by buddy taping to an adjacent digit for 10-14 days is an acceptable alternative treatment.

Obtain postreduction radiographs. Assess functional stability with stress views. This confirms correct joint alignment and congruity and identifies subtle fractures, especially chip or avulsion fractures.

Assess neurovascular status following reduction.

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Consultations

Joint instability or neurovascular compromise after reduction requires immediate orthopedic or hand consultation. Because joint instability or dysfunction and subtle ligamentous, cartilaginous, or bony injury often are obscured by extensive edema and pain immediately after the injury, all finger joint dislocations should be referred for orthopedic or hand specialist evaluation within 2-3 weeks following reduction.

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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, American College of Emergency Physicians

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Chief Editor

Trevor John Mills, MD, MPH Chief of Emergency Medicine, Veterans Affairs Northern California Health Care System; Professor of Emergency Medicine, Department of Emergency Medicine, University of California, Davis, School of Medicine

Trevor John Mills, MD, MPH is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians

Disclosure: Nothing to disclose.

Additional Contributors

James E Keany, MD, FACEP Associate Medical Director, Emergency Services, Mission Hospital Regional Medical Center, Children's Hospital of Orange County at Mission

James E Keany, MD, FACEP is a member of the following medical societies: American College of Emergency Physicians, American College of Sports Medicine, California Medical Association

Disclosure: Nothing to disclose.

Acknowledgements

Tom Scaletta, MD President, Smart-ER (http://smart-er.net); Chair, 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

Disclosure: Nothing to disclose.

References
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  2. Córdoba-Fernández A. Management of nonreducible lesser toe interphalangeal dislocation: an unusual injury. J Am Podiatr Med Assoc. 2012 May-Jun. 102 (3):252-5. [Medline].

  3. Chung S, Sood A, Lee E. Principles of management in isolated dorsal distal interphalangeal joint dislocations. Eplasty. 2014. 14:ic33. [Medline].

  4. Banerji S, Bullocks J, Cole P, Hollier L. Irreducible distal interphalangeal joint dislocation: a case report and literature review. Ann Plast Surg. 2007 Jun. 58(6):683-5. [Medline].

  5. Morisawa Y, Ikegami H, Izumida R. Irreducible palmar dislocation of the distal interphalangeal joint. J Hand Surg [Br]. 2006 Jun. 31(3):296-7. [Medline].

  6. Deshmukh NV, Sonanis SV, Stothard J. Irreducible volar dislocations of the proximal interphalangeal joint. Emerg Med J. 2005 Mar. 22(3):221-3. [Medline].

  7. Chinchalkar SJ, Gan BS. Management of proximal interphalangeal joint fractures and dislocations. J Hand Ther. 2003 Apr-Jun. 16(2):117-28. [Medline].

  8. Freiberg A, Pollard BA, Macdonald MR, Duncan MJ. Management of proximal interphalangeal joint injuries. Hand Clin. 2006 Aug. 22(3):235-42. [Medline].

  9. Cornwall R. Finger metacarpal fractures and dislocations in children. Hand Clin. 2006 Feb. 22(1):1-10. [Medline].

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

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

  12. Gilbert TJ, Cohen M. Imaging of acute injuries to the wrist and hand. Radiol Clin North Am. 1997 May. 35(3):701-25. [Medline].

  13. Joyce KM, Joyce CW, Conroy F, Chan J, Buckley E, Carroll SM. Proximal interphalangeal joint dislocations and treatment: an evolutionary process. Arch Plast Surg. 2014 Jul. 41 (4):394-7. [Medline].

  14. Kozin SH. Fractures and dislocations along the pediatric thumb ray. Hand Clin. 2006 Feb. 22(1):19-29. [Medline].

  15. Kannan RY, Wilmshurst AD. Unstable proximal interphalangeal joint dislocations: another cause. Emerg Med J. 2006 Oct. 23(10):819. [Medline].

  16. Bindra RR, Foster BJ. Management of proximal interphalangeal joint dislocations in athletes. Hand Clin. 2009 Aug. 25(3):423-35. [Medline].

  17. Nanno M, Sawaizumi T, Ito H. Irreducible palmar dislocation of the proximal interphalangeal joint of a finger evaluated by magnetic resonance imaging: a case report. Hand Surg. 2004 Dec. 9(2):253-6. [Medline].

 
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Anteroposterior view of distal interphalangeal (DIP) joint dislocation
Lateral view of distal interphalangeal (DIP) joint dislocation
Oblique view of distal interphalangeal (DIP) joint dislocation
Oblique view of proximal interphalangeal (PIP) joint dislocation
 
 
 
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