Interphalangeal Dislocation Treatment & Management
- Author: Grace M Young, MD; Chief Editor: Trevor John Mills, MD, MPH more...
Splint, ice, and elevate the affected digit.[7, 8] Evaluate neurovascular status before and after transport to the ED.
Emergency Department Care
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.
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.
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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