II. Mechanism

  1. Usually a dorsal dislocation
  2. Typically related to Trauma
  3. Often occurs when ball strikes tip of finger forcing the finger into hyperextension or hyperflexion

III. Signs

  1. Deformity of the distal phalanx (with volar or dorsal angulation)
  2. Evaluate for open dislocation before and after reduction
    1. Any break in the skin around the dislocation is assumed to be from open dislocation (surgical indication)

IV. Differential Diagnosis

  1. Mallet Finger (Extensor tendon rupture)

V. Management: Reduction

  1. Digital Nerve Block
  2. Apply traction while hyperextending dip joint
  3. Apply pressure to base of distal phalanx
  4. Return phalanx to position by flexing dip joint

VI. Management: Post-Reduction

  1. Post-reduction joint assessment
    1. Assess joint range of motion
    2. Assess collateral ligaments with DIP flexed
  2. Immobilization
    1. Initiate active range of motion after Splinting period completed
    2. Volar dislocation
      1. Splint for 2 to 3 weeks in full extension
    3. Dorsal dislocation
      1. Splint for 2 to 3 weeks in 20-30 degrees of flexion
  3. Referral Indications
    1. Complicated dislocation
    2. Unreducible dislocation
    3. Prolonged dislocation
    4. Persistent instability
    5. Open dislocation

VII. Complications

  1. Often associated with open Fractures and dislocations

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