History

History usually reveals a traumatic athletic injury or entrapment of the finger between objects. Typically, the finger was jammed or bent backward during a 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^{[11, 12]}:

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 the entire involved hand

Restriction in active flexion and extension, especially against resistance, suggests tendinous or ligamentous rupture or intra-articular 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.

Differential Diagnoses

Van Ransbeeck H, De Smet L. Double dislocation of both interphalangeal joints in the finger. Case report and literature review. Acta Orthop Belg. 2004 Feb. 70(1):72-5. [QxMD MEDLINE Link].
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. [QxMD MEDLINE Link].
Caggiano NM, Harper CM, Rozental TD. Management of Proximal Interphalangeal Joint Fracture Dislocations. Hand Clin. 2018 May. 34 (2):149-165. [QxMD MEDLINE Link].
Chung S, Sood A, Lee E. Principles of management in isolated dorsal distal interphalangeal joint dislocations. Eplasty. 2014. 14:ic33. [QxMD MEDLINE Link].
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. [QxMD MEDLINE Link].
Morisawa Y, Ikegami H, Izumida R. Irreducible palmar dislocation of the distal interphalangeal joint. J Hand Surg [Br]. 2006 Jun. 31(3):296-7. [QxMD MEDLINE Link].
Hauck T, Müller-Seubert W, Horch RE. [Palmar dislocation of the proximal interphalangeal joint and traumatic boutonnière deformity]. Unfallchirurg. 2017 Oct. 120 (10):873-884. [QxMD MEDLINE Link].
Deshmukh NV, Sonanis SV, Stothard J. Irreducible volar dislocations of the proximal interphalangeal joint. Emerg Med J. 2005 Mar. 22(3):221-3. [QxMD MEDLINE Link].
Charles M. Court-Brown. The Epidemiology of Fractures and Dislocations. www.otaonline.org. Available at https://otaonline.org/book/952/chapter/53360338/the-epidemiology-of-fractures-and-dislocations.
Nina Lightdale-Miric, Scott H. Kozin. Fractures and Dislocations of the Hand and Carpal Bones in Children. www.otaonline.org. Available at https://otaonline.org/book/918/chapter/53008857/fractures-and-dislocations-of-the-hand-and-carpal.
Chinchalkar SJ, Gan BS. Management of proximal interphalangeal joint fractures and dislocations. J Hand Ther. 2003 Apr-Jun. 16(2):117-28. [QxMD MEDLINE Link].
Freiberg A, Pollard BA, Macdonald MR, Duncan MJ. Management of proximal interphalangeal joint injuries. Hand Clin. 2006 Aug. 22(3):235-42. [QxMD MEDLINE Link].
Frueh FS, Vogel P, Honigmann P. Irreducible Dislocations of the Proximal Interphalangeal Joint: Algorithm for Open Reduction and Soft-tissue Repair. Plast Reconstr Surg Glob Open. 2018 May. 6 (5):e1729. [QxMD MEDLINE Link]. [Full Text].
Cornwall R. Finger metacarpal fractures and dislocations in children. Hand Clin. 2006 Feb. 22(1):1-10. [QxMD MEDLINE Link].
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. [QxMD MEDLINE Link].
Sumarriva G, Cook B, Godoy G, Waldron S. Pediatric Complex Metacarpophalangeal Joint Dislocation of the Index Finger. Ochsner J. 2018 Winter. 18 (4):398-401. [QxMD MEDLINE Link]. [Full Text].
Gilbert TJ, Cohen M. Imaging of acute injuries to the wrist and hand. Radiol Clin North Am. 1997 May. 35(3):701-25. [QxMD MEDLINE Link].
Tan RES, Cheah AEJ. Injuries Around the Proximal Interphalangeal Joint. Clin Plast Surg. 2019 Jul. 46 (3):437-449. [QxMD MEDLINE Link]. [Full Text].
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. [QxMD MEDLINE Link].
Kozin SH. Fractures and dislocations along the pediatric thumb ray. Hand Clin. 2006 Feb. 22(1):19-29. [QxMD MEDLINE Link].
Kannan RY, Wilmshurst AD. Unstable proximal interphalangeal joint dislocations: another cause. Emerg Med J. 2006 Oct. 23(10):819. [QxMD MEDLINE Link].
Wang HZ, Zhao JY, Zhang ZS. A novel dynamic distraction external fixator for proximal interphalangeal joint fracture dislocation. J Int Med Res. 2019 Apr. 47 (4):1628-1635. [QxMD MEDLINE Link]. [Full Text].
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. [QxMD MEDLINE Link].
Bindra RR, Foster BJ. Management of proximal interphalangeal joint dislocations in athletes. Hand Clin. 2009 Aug. 25(3):423-35. [QxMD MEDLINE Link].
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. [QxMD MEDLINE Link].