9.26 Finger (PIP Joint) Dislocation
===================================

agk's Library of Common Simple Emergencies

Presentation
------------

The patient will have jammed his finger, 
causing a hyperextension injury that forces the 
middle phalanx dorsally and proximally out of 
articulation with the distal end of the 
proximal phalanx. An obvious deformity will be 
seen unless the patient or a bystander has 
reduced the dislocation on his own. There 
should be no sensory or vascular compromise.

What to do:
-----------

- Unless a shaft fracture is suspected, x rays 
    may be deferred and joint reduction can be 
    carried out first.
- If there has been significant delay in 
    seeking help or the patient is suffering 
    considerable discomfort, a digital block 
    over the proximal phalanx will allow for a 
    more comfortable reduction
- To reduce the joint, do not pull on the 
    fingertip; instead, push the base of the 
    middle phalanx distally, using your thumb 
    until it slides smoothly into its natural 
    anatomical position.
- Now test the finger for collateral ligament 
    instability and avulsion of the central 
    extensor tendon slip. The patient should be 
    able to extend his finger at the proximal 
    interphalangeal (PIP) joint. Testing for 
    avulsion of the volar carpal plate, you 
    will be able to hyperextend the PIP joint 
    more than that of the same finger on the 
    uninjured hand. If any of these associated 
    injuries exist, orthopedic consultation 
    should be sought and prolonged splinting 
    and rehabilitation will be required.
- Post-reduction x-rays should be taken. "Chip 
    fractures" may represent tendon or ligament 
    avulsions.
- Splint in extension for 3-4 days and provide 
    followup for actiive range of motion 
    exercises to restore normal joint mobility.
- Inform the patient that joint swelling and 
    stiffness may persist for months after the 
    initial injury.
- Remind the patient to keep the injured finger 
    elevated. Recommend ice application for the 
    next 24 hours and aspirin for pain.

Discussion
----------

If there is any doubt as to the competence of 
the central extensor slip or the volar carpal 
plate, the joint must be splinted in full 
extension for 3 weeks.

Illustration
------------

img/cse0926.gif

 ----------------------------------------------------
 from Buttaravoli & Stair: COMMON SIMPLE EMERGENCIES
 Longwood Information LLC 4822 Quebec St NW Wash DC
 1.202.237.0971 fax 1.202.244.8393 electra@clark.net
 ----------------------------------------------------