Proximal Interphalangeal Joint Dislocation

Other Names

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

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Background

• This page refers to dislocations, with or without fracture, of the proximal Interphalangeal Joint (Hand)

Epidemiology

• Needs to be updated

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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

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Risk Factors

• Sports
  • Baseball
  • Basketball
  • Football

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Differential Diagnosis

• Fractures
  • Phalanx Fractures (Hand)
  • Metacarpal Fractures
    • Boxer's Fracture
    • Rolando Fracture
    • Bennett Fracture
• Dislocations
  • Metacarpophalangeal Joint Dislocation
  • Proximal Interphalangeal Joint Dislocation
  • Distal Interphalangeal Joint Dislocation
  • Carpometacarpal Joint Dislocation
• Tendinopathies
  • Extensor Tendon Injuries (Hand)
  • Central Slip Extensor Tendon Injury
  • Flexor Tendon Injuries (Hand)
  • Boutonniere Deformity
  • Swan Neck Deformity
  • Jersey Finger
  • Mallet Finger
  • Trigger Finger
  • De Quervains Tenosynovitis
  • Volar Plate Avulsion Injury
  • Sagittal Band Injury
• Ligament Injuries
  • Gamekeepers Thumb (UCL)
  • Radial Collateral Ligament of the Thumb Injury (RCL)
• Neuropathies
  • Wartenbergs Syndrome
  • Carpal Tunnel Syndrome
  • Guyon Canal Syndrome
• Arthropathies
  • Carpometacarpal Arthritis
  • Finger Arthritis
  • Rheumatoid Arthritis
• Nail Bed Injuries
  • Nail Bed Lacerations
  • Nail Bed Avulsions
  • Subungual Hematoma
  • Paronychia
  • Felon
• Pediatric Considerations
  • Proximal Phalanx Avulsion Fracture (Thumb)
  • Middle and Distal Phalanx Avulsion Fracture
• Other
  • Dupuytrens Contracture
  • Intrinsic Plus

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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

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Evaluation

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

Radiology

• Standard Radiographs Hand
  • V sign suggests subtle subluxation

Ultrasound

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

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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

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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

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Rehab and Return to Play

Rehabilitation

• Needs to be updated

Return to Play/ Work

• Needs to be updated

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Complications and Prognosis

Prognosis

• Needs to be updated

Complications

• Metacarpal Fractures
• Phalanx Fractures (Hand)
• Swan Neck Deformity
• Boutonniere Deformity
• Nail Bed Injuries

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See Also

• Hand and Wrist Anatomy (Main)
• Finger Pain (Main)
• Hand Pain (Main)
• Wrist Pain (Main)

External

• Sports Med Review Hand Pain: https://www.sportsmedreview.com/by-joint/hand/

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