Distal interphalangeal dislocation (finger): Difference between revisions
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==Background== | ==Background== | ||
*Uncommon due to firm attachment of skin and | *Uncommon due to firm attachment of skin and subcutaneous tissue to underlying bone | ||
* | *Usually dorsal dislocation | ||
==Clinical Features== | ==Clinical Features== | ||
*Finger pain/deformity | *Finger pain/deformity at DIP joint | ||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
| Line 18: | Line 18: | ||
===[[Splinting]]=== | ===[[Splinting]]=== | ||
*Splint in extension with dorsal splint | *Splint in extension with dorsal splint | ||
==Disposition== | ==Disposition== | ||
* | *If closed dislocation and successfully reduced → Discharge with hand surgery follow-up | ||
*If open or unable to be reduced in ED → hand surgery consult, likely admission | |||
==See Also== | ==See Also== | ||
Revision as of 11:32, 9 February 2019
Background
- Uncommon due to firm attachment of skin and subcutaneous tissue to underlying bone
- Usually dorsal dislocation
Clinical Features
- Finger pain/deformity at DIP joint
Differential Diagnosis
Distal Finger (Including Nail) Injury
- Distal interphalangeal dislocation (finger)
- Distal phalanx (finger) fracture
- Finger amputation
- Fingertip avulsion
- Finger infection
- Nailbed laceration
- Nail avulsion
- Subungual hematoma
Hand and finger dislocations
- Finger dislocations
- Thumb dislocations
- Hand dislocations
Evaluation
- Finger x-ray (PA and lateral)
- True lateral of only the finger instead of hand will help detect subtle avulsion fractures [1]
Management
- Consider digital block for pain control
Dorsal/Posterior
- Flex wrist, then hyperextend the joint
- Apply longitudinal traction followed by dorsal pressure to phalanx base
- Irreducible dislocation likely due to entrapment of avulsion fracture, profundus tendor or volar plate
- Without initial hyperextension, can be difficult to disengage from any trapped soft tissue
- Post reduction, look for central slip rupture, which may lead to Boutonniere deformity
Volar/Anterior
- Flex wrist then hyperflex the affected joint
- Apply gentle traction then extend the joint
- Often need open reduction due to volar plate entrapment
Splinting
- Splint in extension with dorsal splint
Disposition
- If closed dislocation and successfully reduced → Discharge with hand surgery follow-up
- If open or unable to be reduced in ED → hand surgery consult, likely admission
See Also
References
- ↑ Horn A. Management of Common Dislocations. In: Roberts and Hedges' Clinical Procedures in Emergency Medicine. 6th ed. Philadelphia, PA: Elsevier; 2014.