Jump to content
We need you! See something you could improve? Make an edit and help improve WikSM for everyone.

Interphalangeal Joint Dislocation

From WikiSM

Other Names

  • PIPJ Dislocation
  • PIP Joint Dislocation
  • Proximal Interphalangeal Joint Fracture Dislocation
  • PIP Joint Fracture Dislocation
  • Distal Interphalangeal Joint Dislocation
  • DIPJ Dislocation
  • DIP Joint Dislocation

Background

History

  • Needs to be updated

Epidemiology

  • Needs to be updated
  • Epidemiology likely under-stated as many patients will not seek medical attention for simple dislocation

Pathophysiology

Illustration of both volar and dorsal PIPJ dislocations[1]
Lateral radiograph of a proximal interphalangeal joint dorsal fracture-subluxation demonstrating the ‘V’ sign[2]
The ligamentous anatomy of the proximal interphalangeal joint forms a three-sided box involving the proper collateral ligament, the accessory collateral ligament and the palmar (volar) plate.[2]
Stratification of the stability of proximal inter�phalangeal fracture-dislocations based on palmar articular involvement. Fractures involving more than 50% of the joint surface are dorsally unstable whereas fractures involving less than 30% of the joint are usually stable.[2]

General

  • Dislocations of the interphalangeal joints are common in sports
  • Patients present with painful, swollen joint following trauma
  • Most patients can be treated with closed reduction, brief period of immobilizatoin
  • The key determinants of prognosis are timely reduction, restoration of joint congruity, and early mobilization

Dislocation Direction

  • 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

Mechanism of Injury

  • Classic mechanism a ball striking the fingertip with high velocity
  • 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

Anatomy of the Proximal Interphalangeal Joint

  • Proximal Interphalangeal Joint (PIPJ): located between the proximal and middle phalanx
    • The head of the proximal phalanx articulates with the base of the middle phalanx
    • Hinge joint that imparts 9° of supination within its arc of motion[3]
  • Stabilized by

Associated Conditions

Risk Factors

  • Sports[4]
    • Baseball
    • Basketball
    • Football

Differential Diagnosis

Differential Diagnosis Finger And Hand Pain

Clinical Features

Clinical picture (1a) showing swelling, flexion deformity of the PIP joint, shortening and rotated ring finger. Radiographs (1b,c) shows volar dislocation with proximal migration of the middle phalanx (central slip avulsion) and radial deviation (radial collateral ligament injury).[5]

History

  • Patient can usually describe mechanism of injury
  • Complain of pain, swelling, deformity, inability to move finger
  • May have a history of similar injury to the same finger

Physical Exam: Physical Examination Hand

  • Dislocation typically obvious on exam with deformity
  • Important to assess integrity and stability of joint after reduction
  • If fracture is a consideration, image before reduction
  • Evaluate for any open wounds
  • Evaluate for medial/lateral stability by stress testing the collateral ligaments
    • Perform in full extension and 30° of flexion
  • Evaluate competency of volar palte with hyperextension
  • Elsons test evlauates the integrity of the central slip

Special tests

  • Passive stability: lateral stress, hyperextension
  • Elsons 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
Long axis PIPJ ultrasound showing volar dislocation with small avulsion fracture

Radiographs

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

Acute Management

Nonoperative

  • Finger Splint
  • Simple dorsal, volar or lateral dislocation
    • Volar dislocation splinted for 6-8 weeks
  • Buddy tape to adjacent finger
    • Can be used when the joint is complete reduced and stable on stress testing
  • 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
  • Open dislocation

Rehab and Return to Play

Rehabilitation

  • There is a gap in high-level evidence guiding the optimal duration and type of immobilization and rehabilitation protocols
  • Early protected immobilization can begin within days of injury

Return to Play/ Work

  • Early return to play with splinting or taping is indicated if[6]
    • Pain is controlled
    • Joint is stable

Complications and Prognosis

Chronic swan neck deformity in a patient with rheumatoid arthritis

Prognosis

  • Favorable prognosis if
    • Injury is promptly recognized, reduced and managed appropriately
    • Most patients regain full functional use of the finger
  • Simple dislocations without significant ligamentous or bony injuries[7]
    • Good outcomes with reduction and early mobilization
  • More complex injuries such as fracture-dislocations, chronic unreduced have longer term risk

Complications

See Also

Internal

External

References

  1. ↑ Image courtesy of surgeryreference.aofoundation.org
  2. ↑ 2.0 2.1 2.2 Kolovich, Gregory P., and John J. Heifner. "Proximal interphalangeal joint dislocations and fracture-dislocations." Journal of Hand Surgery (European Volume) 48.2_suppl (2023): 27S-34S.
  3. ↑ Leibovic, Stephen J., and William H. Bowers. "Anatomy of the proximal interphalangeal joint." Hand clinics 10.2 (1994): 169-178.
  4. ↑ Freiberg A. Management of proximal interphalangeal joint injuries. Can J Plast Surg. 2007;15(4):199–203.
  5. ↑ Jerome, Terrence Jose J. "Volar dislocation of the proximal interphalangeal joint." Orthoplastic Surgery 5.C (2021): 6-8.
  6. ↑ Prucz, Roni B., and Jeffrey B. Friedrich. "Finger joint injuries." Clinics in sports medicine 34.1 (2015): 99-116.
  7. ↑ Khouri, Joseph S., Jacob MP Bloom, and Warren C. Hammert. "Current trends in the management of proximal interphalangeal joint injuries of the hand." Plastic and reconstructive surgery 132.5 (2013): 1192-1204.
  8. ↑ Haase, Steven C., and Kevin C. Chung. "Current concepts in treatment of fracture-dislocations of the proximal interphalangeal joint." Plastic and reconstructive surgery 134.6 (2014): 1246-1257.
  9. ↑ Bamal, Rahul, and Randy Bindra. "Open reduction of neglected dislocations of the proximal interphalangeal joint." The Journal of hand surgery 45.10 (2020): 991-e1.
Created by:
John Kiel on 18 June 2019 23:09:27
Last edited:
15 August 2025 21:00:15
Categories:
Retrieved from "https://wikism.org/w/index.php?title=Interphalangeal_Joint_Dislocation&oldid=36462"