Distal interphalangeal dislocation (finger)

Background

• Uncommon due to firm attachment of skin and subq tissue to underlying bone
• When dislocations do occur usually are dorsal

Differential Diagnosis

Hand and finger dislocations

• Finger dislocations
  • Distal interphalangeal dislocation (finger) (DIP)
  • Proximal interphalangeal dislocation (finger) (PIP)
  • Metacarpophalangeal dislocation (finger) (MCP)
• Thumb dislocations
  • Interphalangeal dislocation (thumb) (IP)
  • Metacarpophalangeal dislocation (thumb) (MCP)
• Hand dislocations
  • Carpometacarpal dislocation

Management

• Consider digital block for pain control

Dorsal/Posterior

• Flex wrist, then hyperextend the joint
• Apply longitudinal traction followed by dorsal pressure to phalanx base
• Irreducible dislocation likely due to entrapment of avulsion fracture, profundus tendor or volar plate
  • Without initial hyperextension, can be difficult to disengage from any trapped soft tissue
• Post reduction, look for central slip rupture, which may lead to Boutonniere deformity

Volar/Anterior

• Flex wrist then hyperflex the affected joint
• Apply gentle traction then extend the joint
• Often need open reduction due to volar plate entrapment

Splinting

• Splint in slight flexion with dorsal splint x 3wk

See Also

• Hand and finger dislocations