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Proximal Interphalangeal Joint Dislocation
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Contents
Other Names
- PIPJ Dislocation
- PIP Joint Dislocation
- Proximal Interphalangeal Joint Fracture Dislocation
Background
- This page refers to dislocations, with or without fracture, of the proximal Interphalangeal Joint (Hand)
History
Epidemiology
- Needs to be updated
Pathophysiology
- 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
- Fractures
- Dislocations
- Tendinopathies
- Ligament Injuries
- Neuropathies
- Arthropathies
- Nail Bed Injuries
- Pediatric Considerations
- Other
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
Radiology
- Standard Radiographs Hand
- V sign suggests subtle subluxation
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
- Metacarpal Fractures
- Phalanx Fractures (Hand)
- Swan Neck Deformity
- Boutonniere Deformity
- Nail Bed Injuries
See Also
External
- Sports Med Review Hand Pain: https://www.sportsmedreview.com/by-joint/hand/
References
- ↑ 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
Authors:
Last edited:
16 October 2022 00:17:00
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