Diagnostic Considerations
Always check active extension at the proximal interphalangeal (PIP) joint against resistance. Failure to perform an adequate assessment of the stability of reduction is a concern. Failure to diagnose persistent subluxation or tissue trapped in a joint because of the absence of gross deformity is also a concern.
Be suspicious of decreased range of motion (ROM) to avoid missing an open dislocation that was reduced before presentation. Be suspicious of any lacerations near interphalangeal joints in a patient with a jammed finger.
In addition to the conditions listed in the differential diagnosis, other problems to be considered include the following:
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Chronic deformity
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Collateral ligament injury
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Hand soft tissue infections, acute hand arthritis
Differential Diagnoses
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Hand Injury, Soft Tissue
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Mallet Fracture
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Carpometacarpal joint dislocation.
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Carpometacarpal joint dislocation.
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Volar proximal interphalangeal (PIP) joint dislocation.
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Dorsal thumb interphalangeal dislocation.
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Dorsal thumb interphalangeal dislocation.
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Aluminum foam splints.
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Hand dislocation. Dorsal aluminum foam splint.
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Buddy taping.
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Acute dorsal proximal interphalangeal joint fracture-dislocation.
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Acute dorsal proximal interphalangeal fracture-dislocation. A concentric reduction could not be maintained in a splint.
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Complex second metacarpophalangeal dislocation in a skeletally immature patient (same patient as in the next 2 images). Note the position of the finger and dimpling of skin on volar hand.
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Radiograph of the hand of a patient with complex second metacarpophalangeal dislocation (same patient as in the previous and next images).
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Intraoperative photo of the second metacarpophalangeal joint (same patient as in the previous 2 images). Note the displaced volar plate between the metacarpal head and the proximal phalanx.
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Boutonniere deformity.
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Normal lateral band location, dorsal to the axis of rotation of the proximal interphalangeal joint.
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After central slip disruption, lateral bands migrate volar to the axis of rotation of the proximal interphalangeal joint.
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Lateral view of relevant finger anatomy.
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Anteroposterior radiograph displaying a gamekeeper's fracture.
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Lateral radiograph displaying a gamekeeper's fracture.
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Ruptured ulnar collateral ligament.
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Completed UCL repair using suture anchors for fixation (same patient as in the image above).
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Radiograph displaying a stress test of a torn ulnar collateral ligament.
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Complex unstable fracture of the proximal phalanx.
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Displaced fourth and fifth metacarpal fractures, anteroposterior view.
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Displaced fourth and fifth metacarpal fractures, lateral view.
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Fourth and fifth metacarpal fractures, oblique view.
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Fourth and fifth metacarpal fractures after intramedullary pinning, anteroposterior view.
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Fourth and fifth metacarpals after intramedullary pinning, lateral view.
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Digital block.
Tables
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- Overview
- Presentation
- DDx
- Workup
- Treatment
- Approach Considerations
- Acute Phase: Closed Reduction and Traction
- Acute Phase: Physical and Occupational Therapy
- Acute Phase: Open Reduction, Fixation, and Surgical Repair
- Recovery Phase for Hand Dislocation
- Maintenance Phase for Hand Dislocation
- Prevention
- Activity
- Consultations for Hand Dislocation
- Long-Term Monitoring
- Show All
- Medication
- Media Gallery
- References