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Distal Interphalangeal Joint Dislocation

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Other Names

  • DIPJ Dislocation
  • DIP Joint Dislocation

Background

  • Traumatic injury to the distal interphalangeal joint
  • Can be volar, dorsal, lateral with dorsal being far more common

Pathophysiology

  • Dorsal fracture-dislocations occur as a result of hyperextension
  • Volar fracture-dislocations occur as a result of failure of the central slip
  • Impaction shear results from axial loading which can result in volar or dorsal dislocations

Risk Factors

  • Unknown

Differential Diagnosis


Clinical Features

  • General: Physical Examination Hand
  • Dislocation typically obvious on exam with deformity
  • Important to assess integrity and stability of joint after reduction

Evaluation


Classification

  • Dislocations: dorsal, volar, lateral
  • Fracture-Dislocations: dorsal, volar

Management

Acute Management

  • Consider digital block for pain control
  • Dorsal reduction
    • Flex wrist, hyperextend joint, apply traction and dorsal pressure to phalanx base
    • If irreducible, likely soft tissue or bone interposed in joint (avulsion fracture, profundus tendor or volar plate)
  • Volar reduction
    • Flex wrist, hyperflex joint, apply traction and bring joint into extension
    • If irriducible, consider volar plate interposition

Nonoperative

  • First line therapy
  • Dorsal: extension block splinting in slight flexion (prevent extension)
  • Volar: extension splinting (prevent flexion)

Operative

  • Failure of closed reduction
  • Interposition of FDP tendon

Return to Play

  • Needs to be updated

Complications


See Also


References


Created by:
John Kiel on 18 June 2019 23:09:30
Authors:
Last edited:
28 October 2020 13:43:44
Categories: