Distal interphalangeal dislocation (finger)

Background

Distal interphalangeal dislocation (DIP), proximal interphalangeal dislocation (PIP), and metacarpophalangeal dislocation (MCP) joints of the finger shown.

Volar/anterior finger anatomy.

Lateral finger anatomy.

• Uncommon due to firm attachment of skin and subcutaneous tissue to underlying bone
• Usually dorsal dislocation

Hand Anatomy

• Volar = anterior = dorsal
• Dorsal = posterior = palmar

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
  • Distal interphalangeal dislocation (finger) (DIP)
  • Proximal interphalangeal dislocation (finger) (PIP)
  • Metacarpophalangeal dislocation (finger) (MCP)
• Thumb dislocations
  • Interphalangeal dislocation (thumb) (IP)
  • Metacarpophalangeal dislocation (thumb) (MCP)
• Hand dislocations
  • Carpometacarpal dislocation

Evaluation

• Finger x-ray (PA and lateral)
  • True lateral of only the finger instead of hand will help detect subtle avulsion fractures

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

• Hand and finger dislocations