Hand

DIP Dislocation

search

DIP Dislocation, Distal Interphalangeal Joint Dislocation, Finger Dislocation at DIP Joint

  • Mechanism
  1. Usually a dorsal DIP Dislocation
  2. Typically related to Trauma
  3. Often occurs when ball strikes tip of finger forcing the finger into hyperextension or hyperflexion
  • Signs
  1. Deformity of the distal phalanx (with volar or dorsal angulation)
  2. Evaluate for open dislocation before and after reduction
    1. Any break in the skin around the dislocation is assumed to be from open dislocation (surgical indication)
  • Differential Diagnosis
  1. Mallet Finger (Extensor tendon rupture)
  • Management
  • Reduction
  1. Digital Nerve Block
  2. Apply traction while hyperextending dip joint
  3. Apply pressure to base of distal phalanx
  4. Return phalanx to position by flexing dip joint
  5. Apply finger splint in gentle flexion (or buddy tape)
  • Management
  • Post-Reduction
  1. Post-reduction joint assessment
    1. Assess joint range of motion
    2. Assess collateral ligaments with DIP flexed
  2. Immobilization
    1. Initiate active range of motion after Splinting period completed
    2. Volar dislocation
      1. Splint for 2 to 3 weeks in full extension
    3. Dorsal dislocation
      1. Splint for 2 to 3 weeks in 20-30 degrees of flexion
  3. Orthopedic Referral Indications
    1. Complicated dislocation
    2. Unreducible dislocation
    3. Prolonged dislocation
    4. Persistent instability
    5. Open dislocation
  • Complications
  • Open Dislocation
  1. Open dislocations are common at the DIP joint
  2. Open dislocations (and Fractures) may interfere with reduction (interposed tissue)
  3. Infection risk
    1. Consider Antibiotics (no definitive evidence)
    2. Extensive irrigation is warranted
    3. Consult Orthopedics for significantly contaminated wounds (for additional joint washout)
  • References
  1. Warrington (2024) Crit Dec Emerg Med 38(2): 22
  2. Borchers (2012) Am Fam Physician 85(8): 805-10 [PubMed]
  3. Childress (2022) Am Fam Physician 105(6): 631-9 [PubMed]
  4. Leggit (2006) Am Fam Physician 73(5): 827-34 [PubMed]
  5. Oetgen (2008) Curr Rev Musculoskelet Med 1(2):97-102 [PubMed]