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Proximal Interphalangeal Joint Dislocation

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Other Names

  • PIPJ Dislocation
  • PIP Joint Dislocation
  • Proximal Interphalangeal Joint Fracture Dislocation

Background

History

Epidemiology

  • Needs to be updated

Pathophysiology

Long axis PIPJ ultrasound showing volar dislocation with small avulsion fracture
  • Dislocations can be dorsal, volar or lateral
    • Most common dorsal dislocations are due to hyperextension with axial loading
    • Volar plate ruptures from its distal attachment with or without avulsion fracture of the base of the middle phalanx
  • Volar dislocations may be straight volar, lateral volar or rotary
    • Results from a varus or valgus force couple with a volar thrust to middle phalanx
    • Typically collateral ligament, central slip and retinacular ligament along with potential injury to volar plate
  • Can also be fracture-dislocation

Risk Factors

  • Sports[1]
    • Baseball
    • Basketball
    • Football

Differential Diagnosis


Clinical Features

  • History
    • Patient can usually describe mechanism of injury
    • Complain of pain, swelling, deformity, inability to move finger
  • Physical Exam: Physical Examination Hand
    • Dislocation typically obvious on exam with deformity
    • Important to assess integrity and stability of joint after reduction
  • Special tests
    • Passive stability: lateral stress, hyperextension
    • Elson's Test: assess integrity of central slip
    • Active stability: flexion, extension

Evaluation

Proximal Interphalangea Joint Dislocation of the 5th digit on the lateral view hand XR

Radiology

Ultrasound

  • Can be used to evaluate joint
  • Useful to evaluate post-reduciton as well

Classification

  • Dorsal
    • Simple: hyperextension deformity, base of middle phalanx stays in contact with condyles of proximal phalanx
    • Complex: bayonet deformity, shortening with loss of articulation
      • volar plate can block reduction
  • Volar
    • Simple: dislocation without rotational deformity
    • Complex: dislocation with rotational deformity
  • Lateral
    • Rupture of collateral ligament

Management

Nonoperative

  • Simple dorsal, volar or lateral dislocation
    • volar dislocation splinted for 6-8 weeks
  • Buddy tape to adjacent finger
  • Be sure to assess joint after reduction
  • Can use extension block splinting if unstable

Operative

  • Failure of closed reduction
    • Dorsal: prevented by volar plate
    • Volar: FDP tendon
    • Lateral: lateral band interoposition

Rehab and Return to Play

Rehabilitation

  • Needs to be updated

Return to Play/ Work

  • Needs to be updated

Complications and Prognosis

Prognosis

  • Needs to be updated

Complications


See Also


References


  1. Freiberg A. Management of proximal interphalangeal joint injuries. Can J Plast Surg. 2007;15(4):199–203.
Created by:
John Kiel on 18 June 2019 23:09:27
Last edited:
31 August 2021 23:08:04
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