Dorsal PIP Dislocation

Aka: Dorsal PIP Dislocation, Dorsal Proximal Interphalangeal Joint Dislocation, Finger Dislocation at Dorsal PIP Joint

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II. Epidemiology

  1. Most common finger dislocation

III. Mechanism

  1. Occurs due to blow to end of finger with hyperextension

IV. Exam

  1. See Interphalangeal Joint Dislocation

V. Signs

  1. Finger deformity at middle phalanx dorsum
  2. Volar plate tenderness to palpation
    1. Splinting for 4 to 6 weeks if Volar Plate Injury suspected

VI. Complications

  1. Proximal, Middle Phalanx Fracture
  2. Volar plate Fracture is commonly present
    1. Surgery may be needed if involves >30-40% of joint surface
    2. Risk of PIP flexion deformity if not repaired

VII. Imaging: Post-Reduction Evaluation

  1. Subluxation or PIP joint instability
  2. Volar plate Fracture

VIII. Management: Reduction in clinical setting

  1. See reduction on the sideline below
  2. Local Anesthesia if >1 hour since dislocation
    1. Digital Nerve Block or
    2. Joint block
  3. Maneuver (usually effective)
    1. Hand 1: Hold proximal phalanx to stabilize
    2. Hand 2: Hold middle phalanx for traction/pressure
      1. Apply distal traction
      2. Volar directed pressure at middle phalanx base
      3. Deformity obviously reduces with maneuver
  4. Additional measures if refractory to above
    1. Hyperextend distal part and retry maneuver above
    2. Hand 1 (proximal) can apply gentle pressure at base of dislocated phalanx, pushing the phalanx distally
    3. Difficult reduction suggests interposed tissue

IX. Management: Reduction on sideline

  1. Reduce with maneuver above
    1. May forego finger XRay prior to reduction
    2. Digital Block not needed if <1 hour from injury
  2. Criteria for completing game
    1. Affected finger splinted with buddy tape and
    2. Straight-forward reduction and
    3. Stable joint assessment (see above)
  3. Follow-up in clinic
    1. Requires clinical assessment and
    2. Finger XRay

X. Management: Post-reduction

  1. Joint evaluation post-reduction
    1. Imaging as above
    2. Assess joint range of motion
    3. Assess collateral ligaments with PIP flexed
    4. Assess volar plate by palpation and hyperextending joint
    5. Extend flexed pip against resistance
      1. Inability suggests central slip disruption
      2. Refer abnormal exams to orthopedics (Boutonniere risk)
  2. Management
    1. Immbolize for 4 to 6 weeks if Volar Plate Injury suspected
    2. Immobilize for 3 weeks
      1. First: Splint 1-2 weeks
        1. orthoFingerDorsalExtensionBlockSplint.jpg
        2. Dorsal extension block splint in 20-30 degrees of flexion at PIP joint
        3. Aluminum Foam splint affixed to dorsal finger
          1. Splint extends from distal tip to proximal Metacarpals
          2. Splint taped to finger at the proximal phalanx and distal Metacarpal
          3. DIP and PIP joints are allowed to flex freely, but splint prevents extension of finger
      2. Next: Buddy tape finger for additional 1 to 2 weeks
    3. Early range of motion and strengthening
  3. Follow-up
    1. Repeat XRay and evaluation in one week
  4. Orthopedic referral indications
    1. Unable to relocate joint despite above maneuvers
    2. Avulsion Fracture involving more than 30-40% of the interphalangeal joint surface
    3. Incomplete extension following reduction

XI. Complications

  1. Chronic Pain
  2. Degenerative joint changes at the dislocated joint
  3. Functional loss (loss of range of motion)

XII. References

  1. Borchers (2012) Am Fam Physician 85(8): 805-10 [PubMed]
  2. Childress (2022) Am Fam Physician 105(6): 631-9 [PubMed]
  3. Leggit (2006) Am Fam Physician 73(5): 827-34 [PubMed]
  4. Oetgen (2008) Curr Rev Musculoskelet Med 1(2):97-102 [PubMed]

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