Proximal interphalangeal dislocation (finger)
Revision as of 11:25, 16 October 2016 by Rossdonaldson1 (talk | contribs) (Rossdonaldson1 moved page Proximal interphalangeal (PIP) dislocation (finger) to Proximal interphalangeal dislocation (finger))
Background
- Also known as the PIP joint
- Common; due to axial load and hyperextension
- Dorsal dislocation occurs when volar plate ruptures
- Lateral dislocations occur when one of collateral ligaments ruptures with at least partial avulsion of volar plate from middle phalanx
Clinical Features
Differential Diagnosis
Hand and finger dislocations
- Finger dislocations
- Thumb dislocations
- Hand dislocations
Evaluation
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
- Stable Reduction: 3wk of immobilization in 20-30 deg of flexion
- Unstable reduction: Surgery
- Displacement occurs during active range of motion
- Displacement occurs during passive stressing of joint
- >20 deg of deformity and instability with lateral testing