Hand: Finger dislocations

Most finger joint dislocations can be treated without surgery, except for some metacaphophalangeal joint dislocations.

Treatment usually can be safely provided with local anesthetic injection.

Early resumption of motion is necessary to avoid development of stiffness.

When finger dislocations are neglected, treatment can be difficult or unsuccessful. Stiffness is common, even after successful joint reduction.

Case study: A 6 week old neglected interphalangeal joint dislocation

A laborer in his 40's, who presented with a thumb "sprain" of 6 weeks duration. The injury occurred while playing with his son. The patient did not seek medical attention at the time of the injury, he had expected the injury to get better on its own. It did not get better, and the patient eventually found the way to our clinic.

Glossary

Interphalangeal refers to the joint between the phalanges, the finger bones. The thumb has only one interphalangeal (IP) joint, whereas the index, long, ring, and small finger have 2 IP joints each: a proximal IP, and a distal IP joint.

Here is what the finger looked like on presentation:

And here are the xrays, which show a dislocation of the IP joint of the thumb.

Immediate closed reduction is usually performed by ER physicians, usually without orthopedic surgeon's involvement, and is sufficient treatment for these injuries.

At 6 weeks after the injury this was going to be impossible to reduce without surgery, due to contracture and scarring of the soft tissues. An attempt was made, per patient's request, and against my better judgement. The finger was anesthetized with lidocaine, but reduction was not possible.

Surgical treatment was performed next day. Open reduction was performed with a volar approach. The flexor tendon was pulled to the side and the finger was hyperextended. Release of scar from the distal dorsal part of the proximal phalanx did the trick. The joint was then reduced.

Even after reduction the joint was not stable. A dorsal blocking pin was placed to keep the reduction.

The pin was removed at 3 weeks. By 6 weeks the patient had recovered 45 degrees of flexion, compared to almost 80 on the unaffected thumb.

These are the xrays at 6 weeks.

The patient has a cosmetic and very functional thumb, but the open surgery would have been avoided if he had come in the clinic 6 weeks earlier. The ultimate range of motion would have been a bit better as well.