Ver el código de «Hand and finger dislocations»

==DIP Joint==
*Uncommon due to firm attachment of skin and subq tissue to underlying bone
*When dislocations do occur usually are dorsal
===Reduction===
*Digital nerve block
*Apply longitudinal traction/ hyperextension followed by dorsal pressure to phalanx base
*Irreducible cases due to entrapment of avulsion fx, profundus tendor or volar plate
===Management===
*Splint in slight flexion w/ dorsal splint x3wk

==PIP Joint==
*Common; due to axial load and hyperextension
*Dorsal dislocation occurs when volar plate ruptures
*Lateral dislocations occur when one of collateral ligaments ruptures w/ at least partial avulsion of volar plate from middle phalanx
===Reduction===
*Same as for DIP joint
===Management===
*Stable Reduction: 3wk of immobilization in 20-30 deg of flexion
*Unstable reduction: Surgery
**Displacement occurs during active range of motion
**Displacement occurs during passive stressing of joint
**>20 deg of deformity and instability w/ lateral testing

==MCP Joint==
*Usually due to hyperextension forces that rupture volar plate causing dorsal dislocation
*Two types:
**Simple: subluxation
***Joint appears hyperextended to 60-90 deg
**Complex: dislocation
***MCP joint is in moderate hyperextension w/ metacarpal head prominent in palm
***Volar plate is interposed in MCP joint space
***X-ray may show seasamoid within joint space (pathognomonic)
****Closed reduction is not possible
===Reduction===
*Do NOT hyperextend joint (may convert subluxation into complete dislocation)
*Flex the wrist to relax the flexor tendon
*Apply pressure over dorsum of proximal phalanx in distal and volar direction
===Management===
*Splint w/ MCP joint in flexion
*Refer to hand surgeon

==CMC Joint==
*Uncommon due to strong ligaments and insertions of wrist flexors/extensors
**Cause is usually result of high-sped mechamisms
*Dislocates usually dorsally and associated w/ fracture(s)
===Reduction===
*Traction and flexion w/ simultaneous longitudinal pressure on metacarpal base
===Management===
*Refer to hand surgeon

==Thumb ==
===IP Joint===
*Uncommon
*Dislocations often associated w/ open injuries
====Reduction====
*Median nerve block
*Reduce similar to IP joint of other digits
====Management====
*Immobilization in mild flexion for 3wk is usually all that is required
===MCP Joint===
*Like other MCP joint dislocations, may be simple or complex
====Reduction====
*Radial and median nerve blocks
*Pressure directed distally on base of prox phalanx w/ metacarpal flexed and abducted
====Management====
*Stable reduction: Immobilize in thumb spica w/ MCP joint in 20 deg flexion for 4wk
*Unstable reduction: ORIF

===MCP Ulnar Ligament Rupture===
*Also known as gamekeeper's thumb or skier's thumb
*Ulnar ligament ruptures at insertion into prox phalanx (due to radial deviation of MCP)
*X-ray (perform before joint stressing)
**Bony avulsion from insertion of UCL into proximal phalanx
**Associated condylar fracture
**Proximal phalanx volar subluxation and radial deviation suggests complete UCL rupture
*Exam
**Swelling and localized tenderness over ulnar border of joint
**Weakness of pinch
**Partial versus complete rupture
***Valgus stress testing with joint in full extension and in 30 deg of flexion
****>35 deg of joint laxity or 15 deg of laxity beyond that present in uninjured thumb is consistent w/ complete UCL rupture

====Management====
*Partial rupture
**Immobilize in thumb spica for 4wk
*Full rupture
**Referral w/in 1wk

==Source==
*Tintinalli's
*Rosen's

[[Category:Ortho]]