PIP dislocation

HPI:

27 yo male playing basketball “jammed” his right ring finger which was immediately followed by pain, shortening of the digit and inability to flex his finger.

Exam:

Obvious deformity at the right ring finger PIP joint with associated ecchymosis. Sensation to light touch intact and good capillary refill at the affected finger. Patient unable to flex at affected digit. No other identifiable injuries noted.

Images:

• Obtain AP, Lateral, AND at least two oblique views for proper identification of small avulsion fractures.
  

Dorsal dislocation:

Discussion:

• Dorsal dislocations are the most common and are often accompanied by volar plate avulsion.
  
• Caused by hyperextension injury
  
• Volar dislocations are often unstable and non-reducible requiring operative intervention.
  
• Caused by compression and rotation of flexed PIP joint

Management:

• Closed reduction often all that is required for dorsal dislocations.
  
• Hyperextend, utilize traction, and mild flexion of affected joint.
  
• For irreducible, complex, or fracture dislocations operative repair is often required.
  
• Following reduction, buddy taping with or without splinting is all that is immediately required.
  
• Prompt follow-up 10-14 days with an orthopedic hand specialist.

Key Points:

• As with most dislocations, early reduction is important
  
• Splinting is not necessarily required
  
• Dorsal dislocations are most common

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2696003/
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