Distal interphalangeal dislocation (finger): Difference between revisions
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==Background== | ==Background== | ||
[[File:DIP, PIP and MCP joints of hand.jpg|thumb|Distal interphalangeal dislocation (DIP), proximal interphalangeal dislocation (PIP), and metacarpophalangeal dislocation (MCP) joints of the finger shown.]] | |||
*Uncommon due to firm attachment of skin and | [[File:Gray337.png|thumb|Volar/anterior finger anatomy.]] | ||
* | [[File:Gray338.png|thumb|Lateral finger anatomy.]] | ||
*Uncommon due to firm attachment of skin and subcutaneous tissue to underlying bone | |||
*Usually dorsal dislocation | |||
{{Hand anatomy}} | |||
==Clinical Features== | ==Clinical Features== | ||
*Finger pain/deformity | *Finger pain/deformity at DIP joint | ||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
{{DDX distal finger}} | |||
{{Hand and finger dislocation types}} | {{Hand and finger dislocation types}} | ||
==Evaluation== | ==Evaluation== | ||
*Finger x-ray (PA and lateral) | *Finger x-ray (PA and lateral) | ||
**True lateral of only the finger instead of hand will help detect subtle avulsion fractures <ref name="Management of Common Dislocations">Horn A. Management of Common Dislocations. In: Roberts and Hedges' Clinical Procedures in Emergency Medicine. 6th ed. Philadelphia, PA: Elsevier; 2014. </ref> | |||
==Management== | ==Management== | ||
| Line 17: | Line 23: | ||
===[[Splinting]]=== | ===[[Splinting]]=== | ||
*Splint in | *Alumifoam splint on side of dislocation | ||
*10-20 degrees of flexion for dorsal dislocation, joint in extension for volar dislocation | |||
*Splint should not extend onto the palm | |||
==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== | ||
*[[Hand and finger dislocations]] | *[[Hand and finger dislocations]] | ||
==External Links== | |||
==References== | ==References== | ||
<references/> | |||
[[Category:Orthopedics]] | [[Category:Orthopedics]] | ||
[[Category:Sports Medicine]] | |||
Latest revision as of 17:34, 14 December 2022
Background
- Uncommon due to firm attachment of skin and subcutaneous tissue to underlying bone
- Usually dorsal dislocation
Hand Anatomy
- Volar = anterior = palmar
- Dorsal = posterior
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
- Alumifoam splint on side of dislocation
- 10-20 degrees of flexion for dorsal dislocation, joint in extension for volar dislocation
- Splint should not extend onto the palm
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
External Links
References
- ↑ Horn A. Management of Common Dislocations. In: Roberts and Hedges' Clinical Procedures in Emergency Medicine. 6th ed. Philadelphia, PA: Elsevier; 2014.