Hand

Volar PIP Dislocation

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Volar PIP Dislocation, Volar Proximal Interphalangeal Joint Dislocation, Finger Dislocation at Volar PIP Joint

  • Epidemiology
  1. Uncommon Interphalangeal Dislocation
  • Signs
  1. Deformity of finger in volar angulation at the PIP Joint
  2. PIP Central Slip Dislocation
    1. Inability to extend finger at PIP joint
  • Imaging
  1. Check Post-reduction films for Fracture
  • Management
  1. Reduction
    1. Use similar method as for Dorsal DIP Dislocation
  2. Post-reduction (If reduction completed)
    1. Evaluate for PIP Central Slip Dislocation
      1. Patient flexes finger at PIP joint to 90 degrees over a table edge, on which the patient's hand rests
      2. Central Slip injury present if DIP may be extended, but not the PIP joint
    2. Splint only the PIP in full extension for 6 weeks
      1. Allows for DIP and MCP range of motion
  3. Referral Indications
    1. Early orthopedic Consultation in most cases
    2. Fracture involves more than 30-40% of intra-articular surface
    3. Difficult or unsuccessful reduction
    4. Patient unable to fully extend finger
  • Complications
  1. Difficult reduction with often interposed soft tissue
  2. Usually associated with central slip disruption (avulsion)
    1. Frequently associated with Boutonniere Deformity
  3. Prolonged swelling and pain
  • References
  1. Borchers (2012) Am Fam Physician 85(8): 805-10 [PubMed]
  2. Childress (2022) Am Fam Physician 105(6): 631-9 [PubMed]
  3. Leggit (2006) Am Fam Physician 73(5): 827-34 [PubMed]
  4. Oetgen (2008) Curr Rev Musculoskelet Med 1(2):97-102 [PubMed]