Interphalangeal Dislocation Treatment & Management

  • Author: Grace M Young, MD; Chief Editor: Rick Kulkarni, MD   more...
 
Updated: May 3, 2011
 

Prehospital Care

  • Splint, ice, and elevate the affected digit.[6, 7]
  • 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)[6, 7]

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.

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.[8, 9, 12] 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 and American College of Emergency Physicians

Disclosure: Nothing to disclose.

Specialty Editor Board

James E Keany, MD, FACEP  Medical Director, TravelMDAssist; Staff Physician, Department of Emergency Services, Mission Hospital Regional Medical Center

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.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Senior Pharmacy Editor, eMedicine

Disclosure: eMedicine Salary Employment

Tom Scaletta, MD  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.

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 

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

References

  1. 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].

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

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

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

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

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

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

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

  9. 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].

  10. 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].

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

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

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

  14. 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. Dec 2004;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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