Smarter Decisions,
Better Care

UpToDate synthesizes the most recent medical information into evidence-based practical recommendations clinicians trust to make the right point-of-care decisions.

  • Rigorous editorial process: Evidence-based treatment recommendations
  • World-Renowned physician authors: over 5,100 physician authors and editors around the globe
  • Innovative technology: integrates into the workflow; access from EMRs

Choose from the list below to learn more about subscriptions for a:


Subscribers log in here


Digit dislocation reduction

INTRODUCTION

Dislocation of a digit is common among skeletally mature adolescents and active young adults. Dorsal displacement of the proximal interphalangeal joint of the finger is the most frequent dislocation [1]. On the other hand, double dislocations of the finger interphalangeal and/or metacarpophalangeal joints are a rare entity [2]. The primary management of digital joint dislocations consists of radiographic exclusion of a fracture, joint reduction after appropriate analgesia and/or regional anesthesia, and splinting.

The reduction of digit dislocations is reviewed here. The treatment of toe and finger fractures is discussed separately. (See "Metatarsal and toe fractures in children" and "Toe fractures in adults" and "Proximal phalanx fractures" and "Middle phalanx fractures" and "Distal phalanx fractures".)

ANATOMY

Finger function involves a complex interaction among multiple joints, flexor and extensor tendons, and supporting fascia and ligaments. Each of the digits, except the thumb, has three phalanges with three hinged joints: distal interphalangeal (DIP), proximal interphalangeal (PIP), and metacarpophalangeal (MCP) (figure 1). Joint stability is provided by the structure of the phalanges, joint capsule, radial and ulnar collateral ligaments, and dorsal and palmar ligaments. (See "Finger and thumb anatomy".)

Flexion and extension are the primary movements of the fingers. Abduction and adduction can be performed at the MCP joints. The thumb is capable of opposition, abduction, adduction, and retropulsion, in addition to flexion and extension.

At the metacarpophalangeal (MCP) joints, lateral motion is limited by the collateral ligaments, which are actually lateral oblique in position rather than true lateral. Triangular in shape, these ligaments arise from the lateral head of each metacarpal bone and attach to the base of the proximal phalanx distally. Because of these anatomical features, the MCP joint is more stable in flexion than in extension due to stabilization by the collateral ligaments (figure 2) [3]. The volar plate is part of the joint capsule that attaches only to the proximal phalanx, allowing hyperextension. The volar plate is the site of insertion for the intermetacarpal ligaments. The intermetacarpal ligaments restrict the separation of the metacarpal heads.

                        

Subscribers log in here

To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information or to purchase a personal subscription, click below on the option that best describes you:
Literature review current through: Oct 2014. | This topic last updated: Jun 14, 2013.
The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2014 UpToDate, Inc.
References
Top
  1. Leggit JC, Meko CJ. Acute finger injuries: part II. Fractures, dislocations, and thumb injuries. Am Fam Physician 2006; 73:827.
  2. Panchal AP, Bamberger HB. Dorsal dislocation of the distal interphalangeal joint and volar dislocation of the metacarpophalangeal joint in the same finger: a case report. Hand (N Y) 2010; 5:200.
  3. Brand PW, Cranor KC, Ellis JC. Tendon and pulleys at the metacarpophalangeal joint of a finger. J Bone Joint Surg Am 1975; 57:779.
  4. Moore KL, Dalley AF. Clinically Oriented Anatomy, 5th, Lippincott Williams & Wilkins, Philadelphia 2005. p.705.
  5. Sorene ED, Regev G. Complex dislocation with double sesamoid entrapment of the interphalangeal joint of the hallux. J Foot Ankle Surg 2006; 45:413.
  6. Mittlmeier T, Haar P. Sesamoid and toe fractures. Injury 2004; 35 Suppl 2:SB87.
  7. Peimer CA, Sullivan DJ, Wild DR. Palmar dislocation of the proximal interphalangeal joint. J Hand Surg Am 1984; 9A:39.
  8. Spinner M, Choi BY. Anterior dislocation of the proximal interphalangeal joint. A cause of rupture of the central slip of the extensor mechanism. J Bone Joint Surg Am 1970; 52:1329.
  9. Kozin SH, Waters PM. Fractures and dislocations of the hand and carpus in children. In: Fractures in Children, 7th, Beaty JH, Kasser JR. (Eds), Lippincott Williams & Wilkins, Philadelphia 2010. p.225.
  10. Jahss MH. Traumatic dislocations of the first metatarsophalangeal joint. Foot Ankle 1980; 1:15.
  11. Stern PJ, Lee AF. Open dorsal dislocations of the proximal interphalangeal joint. J Hand Surg Am 1985; 10:364.
  12. Glickel SZ, Barron OA. Proximal interphalangeal joint fracture dislocations. Hand Clin 2000; 16:333.
  13. McCue FC, Honner R, Johnson MC, Gieck JH. Athletic injuries of the proximal interphalangeal joint requiring surgical treatment. J Bone Joint Surg Am 1970; 52:937.
  14. Benson LS, Bailie DS. Proximal interphalangeal joint injuries of the hand. Part II: Treatment and complications. Am J Orthop (Belle Mead NJ) 1996; 25:527.
  15. Su, JK, Difiori, J. Jammed Finger. Med Sci Sports Exerc 2006; 38:S147.
  16. Hossfeld GE, Uehara DT. Acute joint injuries of the hand. Emerg Med Clin North Am 1993; 11:781.
  17. Johnson FC, Okada PJ. Reduction of common joint dislocations and subluxations. In: Textbook of Pediatric Emergency Procedures, 2nd, King C, Henretig FM. (Eds), Lippincott Williams & Wilkins, Philadelphia 2008. p.963.
  18. Uehara DT. Injuries of the hand and wrist. In: Pediatric Emergency Medicine: A Comprehensive Study Guide, 2nd, Strange GR, Ahrens WR, Lelyveld S, Shafemeyer RW. (Eds), McGraw-Hill, New York 2002. p.147.
  19. Muelleman RL, Wadman MC. Injuries to the hand and digits. In: Emergency Medicine: A Comprehensive Study Guide, 6th, Tintinalli JE, Kelen GD, Stapczynski JS. (Eds), McGraw-Hill, New York 2004. p.1666.
  20. Ostrowski DM, Neimkin RJ. Irreducible palmar dislocation of the proximal interphalangeal joint. A case report. Orthopedics 1985; 8:84.
  21. Itadera E. Irreducible palmar dislocation of the proximal interphalangeal joint caused by a fracture fragment: a case report. J Orthop Sci 2003; 8:872.
  22. Simon RR, Sherman SC, Koenigsknecht SJ. Hand. In: Emergency Orthopedics: The Extremities, 5th, McGraw-Hill, New York 2007. p.123.
  23. Vicar AJ. Proximal interphalangeal joint dislocations without fractures. Hand Clin 1988; 4:5.