Dorsal view left hand

Volar view left hand

Finger dislocation is a common sports injury. Finger proximal interphalangeal joint (PIP) dislocation may be dorsal or volar. Metacarpal phalangeal dislocations are rare and the mechanism is usually hyperextension of joint following a fall on the outstretched hand. The index finger most commonly involved with dorsal dislocation more frequent than the volar type.

PIP joint dislocation.

Dislocation dorsal or may be volar

Injury Mechanism:

• Direct force to hand

Causes:

• Falls on hand

Presentation:

• Pain
• Deformity

Clinically:

• Deformity
• Pain
• Instability

Investigations:

X-ray:

• Assess joint congruity
• Look for V sign that is indicative of joint subluxation
• Assess for associated fracture, with > 40 % joint involvement surgically significant

Management:

Nonoperative:

• Simple, uncomplicated dislocations with congruent reduction without significant articular fracture can be treated with buddy strapping
• After reduction assess congruency and assess the rotation by clinically assessing finger overlapping

Surgery for complex dislocations:

• Joint incongruence
• Intraarticular fracture with > 40 % joint involvement

Finger Buddy strapping

Active wrist ROM after 2 weeks

Finger adduction strengthening

Finger abduction strengthening

Hand grip strengthening

Skin incision

Deep resection:

• Retract lateral band after skin incision
• Periosteal incision and create subperiosteal flaps as needed for additional fracture ORIF

• Approach: mid-axial incision
• Fixation preparation: 1.3 mm anchor or tunnel
• Suture torn ligament and fix to anchor or create tunnels for contralateral side fixation
• Maintain fixation by keeping joint in protected position with K-wire for 3 weeks
• Closure

• Remove K-wire after 3-4 weeks
• Keep palmar finger splint keeping PIP joint in full extension for 1-2 weeks with removal of splint intermittently with buddy strapping to regain protective ROM
• Buddy strapping with increasing finger ROM
• After 6 weeks active flexion and extension
• Resume sporting activities after 12 weeks