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Dorsal PIP Dislocation
Aka: Dorsal PIP Dislocation, Dorsal Proximal Interphalangeal Joint Dislocation, Finger Dislocation at Dorsal PIP Joint
- See Also
- IP Joint Dislocation
- Epidemiology
- Most common finger dislocation
- Mechanism
- Occurs due to blow to end of finger
- Exam
- See Interphalangeal Joint Dislocation
- Signs
- Finger deformity at middle phalanx dorsum
- Volar plate tenderness to palpation
- Complications
- Volar plate Fracture is commonly present
- Surgery may be needed if involves >30-40% of joint surface
- Imaging: Post-Reduction Evaluation
- Subluxation or PIP joint instability
- Volar plate Fracture
- Management: Reduction in clinical setting
- Local Anesthesia if >1 hour since dislocation
- Digital Nerve Block or
- Joint block
- Maneuver (usually effective)
- Hand 1: Hold proximal phalanx to stabilize
- Hand 2: Hold middle phalanx for traction/pressure
- Apply distal traction
- Volar directed pressure at middle phalanx base
- Deformity obviously reduces with maneuver
- Additional measures if refractory to above
- Hyperextend distal part and retry maneuver above
- Hand 1 (proximal) can apply gentle pressure at base of dislocated phalanx, pushing the phalanx distally
- Difficult reduction suggests interposed tissue
- Management: Reduction on sideline
- Reduce with maneuver above
- May forego finger XRay prior to reduction
- Digital Block not needed if <1 hour from injury
- Criteria for completing game
- Affected finger splinted with buddy tape and
- Straight-forward reduction and
- Stable joint assessment (see above)
- Follow-up in clinic
- Requires clinical assessment and
- Finger XRay
- Management: Post-reduction
- Joint evaluation post-reduction
- Imaging as above
- Assess joint range of motion
- Assess collateral ligaments with PIP flexed
- Assess volar plate by hyperextending joint
- Extend flexed pip against resistance
- Inability suggests central slip disruption
- Refer abnormals to orthopedics (Boutonniere risk)
- Management
- Immobilize for 3 weeks in 20-30 degrees of flexion
- First: Splint 1-2 weeks
- Next: Buddy tape finger for additional 1 to 2 weeks
- Early range of motion and strengthening
- Follow-up
- Repeat XRay and evaluation in one week
- Orthopedic referral indications
- Unable to relocate joint despite above maneuvers
- Avulsion Fracture involving more than 30-40% of the interphalangeal joint surface
- Incomplete extension following reduction
- Complications
- Chronic Pain
- Degenerative joint changes at the dislocated joint
- Functional loss (loss of range of motion)
- References
- Borchers (2012) Am Fam Physician 85(8): 805-10 [PubMed]
- Leggit (2006) Am Fam Physician 73(5): 827-34 [PubMed]
- Oetgen (2008) Curr Rev Musculoskelet Med 1(2):97-102 [PubMed]