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Finger Dislocations

It is much more common for children to break a finger than dislocate one. Why? Those darn growth plates. Nevertheless reducing a dislocated digit is one of the most common emergency procedures around and can generally be performed without much difficulty. However there are some situations where you shouldn’t just yank on the digit.

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 Finger Dislocation (PIP Joint) What to Do

To reduce a dorsal dislocation, do not just pull on the fingertip; instead, with the joint slightly extended, push the base of the middle phalanx distally using your thumb while holding the patient’s distal phalanx with your other thumb and index finger. Then, apply traction and gently flex the middle phalanx until it slides smoothly into its natural anatomic position

 Finger dislocation Reduction Technique

Finger dislocation is extremely common. This video shows a very easy technique of reducing finger dislocation.

 Metacarpophalangeal dislocation (finger) Reduction

Traction alone may convert simple MCP dislocation may convert it to a complex dislocation... Flex the wrist to relax the flexor tendon, Hyperextend the joint, Apply pressure over dorsum of proximal phalanx in distal and volar direction.

Articles of Interest

Point Taken: Finger Dislocations

Keep in mind that primarily the IP joints are much more secure than the MCP joints because of the IP joints’ bicondylar arrangement and the fact that the collateral ligaments are tight throughout the entire range of motion. (Medscape, 2014.) Dislocation of any phalanx joint dorsally can cause separation from the volar plate while lateral dislocations can disrupt one or both of the collateral ligaments. Tendon injury and avulsion fractures may also occur.

Do Not Simply Pull a Dislocated Finger (MP Joint)

Metacarpophalangeal dislocation is a rare entity that should be suspected in the presence of a history of digit traumatic hyperextension and typical bayonet position. Tractions should be avoided in the pediatric patient because ligament laxity can lead to the volar plate's displacement, converting a simple dislocation into a complex one. Furthermore, it could worsen the lesion's soft tissues' damage and strengthen the noose around the second metacarpophalangeal head. Therefore, even in a simple dislocation, surgery would be the best choice to be performed on the first day of the trauma.

Finger Dislocation

The foremost common joint to be dislocated is the proximal interphalangeal joint (PIPJ) of the middle joint in the finger. When the forces involved are too much and beyond the capacity what the connective tissue and supporting muscles can withstand, one or more small bones of the fingers can displace or ‘pop out’ of their normal position

It’s Not “Just” a Dislocated Finger…

Finger dislocations are extremely common in ball sports, in fact you may have had one or two yourself. All it takes is a fast-moving ball to hit the end of the finger and – ouch! It’s dislocated. Sometimes, it’s as simple as popping the finger back in, buddy strapping to the next finger and away you go. But often, it’s not so simple. It hurts. Ouch. The finger swells up. Gross. It becomes stiff. Uh-oh. You’re left with a permanently bent, clunky or stiff finger. What the?!. The more often you dislocate the same joint, the more easily it happens until it takes barely anything to pop it out of place. And then what? The only solution is surgical. Well that’s a real pain in the neck.

MCP Dislocations

MCP Dislocations are a dislocation of the metacarpophalangeal joint, usually dorsal, caused by a fall and hyperextension of the MCP joint. Diagnosis can be made clinically and is confirmed by orthogonal radiographs. Treatment is closed reduction unless soft tissue interposition blocks reduction, in which case open reduction is indicated.

PIP dislocations: Volar plate injuries and volar dislocations are high risk

The most common finger dislocation is at the PIP, most often dorsal. Most dorsal dislocations can be reduced with “tip + slip” method with wrist flexion. Dorsal dislocations are sometimes associated with avulsion fractures off the base of the middle phalanx on the volar aspect which indicates a volar plate injury which are high risk injuries. Volar plate injuries as well as PIP dislocations with post-reduction instability require referral to a hand surgeon. Volar dislocation may be associated with central slip injury/tear and can lead to Boutonniere’s deformity and therefore should have follow up with a hand specialist.

Reduction of Common Fractures and Dislocations

Longitudinal traction and hyperextension with applying dorsal pressure to the base of the dislocated phalanx usually reduce the dislocation.

The Epidemiology of Finger Dislocations Presenting for Emergency Care Within the United States

Dislocations of the finger joints are common hand injuries with the proximal interphalangeal (PIP) joint being the most frequently affected site.4 Whether they occur as purely ligamentous injuries or with concomitant fractures, finger joint dislocations can cause significant morbidity manifesting as residual pain and stiffness.

Resources

StatPearls

MCP joint dislocations have a high likely hood of requiring operative intervention, and recovery to preinjury motion takes approximately 4 to 6 weeks. Most PIP joint dislocations are stable after reduction except lateral PIP joint dislocation, as they often require surgical intervention.