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

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