II. Mechanism
- Usually a dorsal DIP Dislocation
- Typically related to Trauma
- Often occurs when ball strikes tip of finger forcing the finger into hyperextension or hyperflexion
III. Signs
- Deformity of the distal phalanx (with volar or dorsal angulation)
- Evaluate for open dislocation before and after reduction
- Any break in the skin around the dislocation is assumed to be from open dislocation (surgical indication)
IV. Differential Diagnosis
- Mallet Finger (Extensor tendon rupture)
V. Management: Reduction
- Digital Nerve Block
- Apply traction while hyperextending dip joint
- Apply pressure to base of distal phalanx
- Return phalanx to position by flexing dip joint
- Apply finger splint in gentle flexion (or buddy tape)
VI. Management: Post-Reduction
- Post-reduction joint assessment
- Assess joint range of motion
- Assess collateral ligaments with DIP flexed
- Immobilization
- Initiate active range of motion after Splinting period completed
- Volar dislocation
- Splint for 2 to 3 weeks in full extension
- Dorsal dislocation
- Splint for 2 to 3 weeks in 20-30 degrees of flexion
- Orthopedic Referral Indications
- Complicated dislocation
- Unreducible dislocation
- Prolonged dislocation
- Persistent instability
- Open dislocation
VII. Complications: Open Dislocation
- Open dislocations are common at the DIP joint
- Open dislocations (and Fractures) may interfere with reduction (interposed tissue)
- Infection risk
- Consider Antibiotics (no definitive evidence)
- Extensive irrigation is warranted
- Consult Orthopedics for significantly contaminated wounds (for additional joint washout)