Distal interphalangeal dislocation (finger): Difference between revisions
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==Background== | ==Background== | ||
*Uncommon due to firm attachment of skin and subq tissue to underlying bone | *Uncommon due to firm attachment of skin and subq tissue to underlying bone | ||
*When dislocations do occur usually are dorsal | **When dislocations do occur usually are dorsal and are frequently open | ||
==Clinical Features== | ==Clinical Features== | ||
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==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== | ||
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===[[Splinting]]=== | ===[[Splinting]]=== | ||
*Splint in | *Splint in extension with dorsal splint x 3wk | ||
==Disposition== | ==Disposition== | ||
*Outpatient | *Outpatient | ||
**If reduction, follow up within two weeks with hand specialist | |||
==See Also== | ==See Also== | ||
Revision as of 14:53, 18 April 2017
Background
- Uncommon due to firm attachment of skin and subq tissue to underlying bone
- When dislocations do occur usually are dorsal and are frequently open
Clinical Features
- Finger pain/deformity
Differential Diagnosis
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 x 3wk
Disposition
- Outpatient
- If reduction, follow up within two weeks with hand specialist
See Also
References
- ↑ Horn A. Management of Common Dislocations. In: Roberts and Hedges' Clinical Procedures in Emergency Medicine. 6th ed. Philadelphia, PA: Elsevier; 2014.