Finger Dislocation Joint Reduction Technique

Updated: Dec 17, 2015
  • Author: Robin Polansky, MD, MPH, FACEP; Chief Editor: Erik D Schraga, MD  more...
  • Print
Technique

Reduction of Dislocated Finger Joint

The videos below demonstrate joint reduction techniques for volar and dorsal dislocations.

Joint reduction for a volar dislocation. Video courtesy of Therese Canares, MD; Marleny Franco, MD; and Jonathan Valente, MD (Rhode Island Hospital, Brown University).
Joint reduction for a dorsal dislocation. Video courtesy of Therese Canares, MD; Marleny Franco, MD; and Jonathan Valente, MD (Rhode Island Hospital, Brown University).

Dislocations of DIP joints of fingers (digits 2-5)

To reduce a dislocated distal interphalangeal (DIP) joint, apply gentle longitudinal traction with hyperextension (if dislocation is dorsal) or hyperflexion (if dislocation is volar), followed by pressure to the base of the distal phalanx in the direction that realigns the phalanges. Splint a volar dislocation without a tendon injury by applying a dorsal splint in mild flexion. To splint a dorsal dislocation without a tendon injury, use a dorsal splint in extension. (See the image below.) If the finger cannot be sufficiently reduced, consult a hand surgeon.

Distal interphalangeal (DIP) joint dorsal splint. Distal interphalangeal (DIP) joint dorsal splint.

Dislocations of PIP joints of fingers (digits 2-5)

Dorsal dislocations

To reduce a dorsal dislocation of the proximal interphalangeal (PIP) joint, apply longitudinal traction with hyperextension, followed by pressure to the dorsal aspect of the base of the middle phalanx as the finger is brought into flexion. Apply a dorsal splint with 20-30° of flexion. If an associated fracture of the volar lip affects more than 33% of the joint surface, a closed reduction will be unstable and operative repair is necessary because the collateral ligament is attached to the bony fragment. [10]

Lateral dislocations

Apply longitudinal traction and ulnar or radial stress to the finger, depending on the initial direction of injury. Partial tears can be buddy-taped; reduced dislocations (ie, complete tears) should be splinted.

Volar dislocations

Apply mild traction with the PIP and metacarpophalangeal (MCP) joints flexed. Splint only the PIP joint in full extension. (See the image below.) Some argue that all volar PIP joint dislocations should be reduced in the operating room, on the grounds that entrapment of the lateral band around the head of the proximal phalanx may block reduction. [8] Strongly consider consultation with a hand surgeon before intervention.

Proximal interphalangeal (PIP) joint dorsal splint Proximal interphalangeal (PIP) joint dorsal splint.

Dislocations of MCP joints of fingers (digits 2-5)

Simple dorsal dislocations (subluxations)

On examination, the MCP joint is hyperextended 60-90°, but the articular surfaces are in contact without irregular soft tissue. On radiography, joint surfaces are in close contact.

This injury can be reduced nonoperatively. Flex the wrist (thereby relaxing the flexor tendons). Hyperextend the affected digit and place pressure over the dorsum of the proximal phalanx in a distal and volar direction. Avoid excessive hyperextension or longitudinal traction, which can convert a simple dislocation to a complex dislocation. Splint in flexion; some argue that buddy-taping is sufficient. [9]

Complex (complete) dorsal dislocations

On examination, the MCP joint is hyperextended and angulated, the metacarpal head is more noticeable in the palm, and the palmar skin is dimpled. On radiography, joint surfaces are separated and a sesamoid bone may be seen within the joint space (pathognomonic of a complex MCP joint dislocation).

This injury must be reduced operatively because the volar plate has been displaced into the MCP joint. Volar, lateral, and complex dorsal MCP joint dislocations of the finger must be evaluated and treated by a hand surgeon. A mild compression dressing with gentle plaster reinforcement is placed temporarily until the patient can be evaluated by a hand surgeon. Arthroscopic reduction of this injury has been described. [11]

Dislocations of IP joint of thumb

To reduce a dislocated thumb interphalangeal (IP) joint, flex the joint with continued traction. Apply direct pressure to the base of the distal phalanx. Stabilize with a thumb spica splint.

Dislocations of MCP joint of thumb

Simple dorsal dislocations (subluxations)

On examination, no soft-tissue swelling is evident, and the MCP joint is hyperextended, but the articular surfaces remain in contact. On radiography, the joint surfaces are in close contact.

This injury can be reduced nonoperatively. Provide adequate anesthesia. Grasp the patient’s thumb firmly. Hyperextend the dislocated proximal phalanx. Push the base of the proximal phalanx in a volar direction. Flex the thumb to relax the flexor pollicis longus. Using traction alone may convert a simple MCP dislocation to a complex dislocation. Stabilize the reduced injury in a thumb spica splint with the MCP joint in 20° of flexion.

Complex (complete) dorsal dislocations

On examination, the MCP joint is hyperextended and angulated, and the metacarpal head is more noticeable in the thenar eminence with skin dimpling. On radiography, the joint surfaces are separated, and a sesamoid bone may be seen within the joint space (pathognomonic of a complex MCP joint dislocation). This injury must be reduced operatively because the volar plate has been displaced into the MCP joint.

Volar dislocations

Apply a dorsally directed force to the volar base of the proximal phalanx. Splint the MCP joint in full extension.

Any thumb MCP joint dislocation associated with a complete rupture of the ulnar collateral ligament must be treated surgically. (This injury renders the patient’s pinch weak and unstable). If the dislocation is not reduced or if the reduction is not successful, place a mild compression dressing with gentle plaster reinforcement and refer the patient to a hand surgeon urgently.

Surgical pearls

Time is of the essence in dislocations. Delay in reduction may lead to swelling and muscle spasm, which make the reduction more challenging.

Obtain a full history, including age, past medical history, hand dominance, prior hand injuries or issues, occupation, mechanism and time of injury, hand position during the injury, and interventions made prior to presentation. [12]

Adequate anesthesia is key to a successful reduction.

Following reduction, joint stability must be checked and postreduction films must be obtained.

Some dislocations require operative reduction because of the location of the volar plate, ligaments, or tendons following the injury.

If reduction is unsuccessful after numerous attempts or if the reduction is not acute, consult with a hand surgeon for possible open reduction and internal fixation.

With any type of dislocation, all patients should be urgently re-evaluated by a hand surgeon.

The most common causes of inability to reduce a dislocation are an avulsion fracture involving the joint, a trapped tendon, a buttonhole tear through the volar plate, and significant swelling. [7]

If a laceration is associated with a dislocation, copious irrigation and laceration repair should precede splinting.

Splinting should not exceed 3 weeks.

Antibiotics and tetanus prophylaxis should be given in the case of an open fracture.

Next:

Complications

Potential complications include the following:

  • Inadequate or delayed reduction (joint instability, joint stiffness, joint deformity)
  • Overaggressive attempts at reduction (fracture)
  • Inadequate immobilization (redislocation)
  • Prolonged immobilization (muscle contracture)
  • Infection (if open fracture exists)
Previous