IP DISLOCATION

Question 1

KEY CONCEPTS

Answer 1

PIP Most Common
Dorsal Most Common
Mechanisms Almost always axial load and hyperextension

LATERAL PIP
Collateral ligament rupture with partial avulsion of the volar plate from middle phalanx
Radial collateral 6 times more common that ulnar collateral

Question 2

MANAGEMENT

Answer 2

XRAY
AP, lateral, oblique
Almost always dorsal dislocation

REDUCTION TECHNIQUE
Dorsal Dislocation: Gentle traction, increase deformity hyperextension
Direct dorsal pressure at the base of the distal phalanx
Volar Dislocation: Gentle traction, increase deformity, hyperflexion

POST REDUCTION EXAMINATION
Evaluate for instability
1. Assess aROM
Full Rom = stable joint
Dislocation with motion = unstable

2. Evaluate Lateral Collateral Ligament laxity (full extension and 30 degrees flexion)

Grade I: pain with no laxity
Grade II: laxity with firm endpoint and stable arc of motion
Grade III: gross instability with no endpoint

3. Elson Test
   For PIP injuries
   Evaluates for central slip injury

POST-REDUCTION MANAGEMENT:

UNSTABLE PIP DORSAL DISLOCATION
Dosal Splint
30 degree PIP flexion 2-3 weeks
Plastics follow up

STABLE PIP DORSAL DISLOCATION
Consider buddy taping vs. Dorsal Splint

PIP AFTERCARE
Dorsal splint in 30 degrees for 1 week then 20 degrees for 1 weeks then 10 degrees for 1 week then buddy tape for 3 weeks

VOLAR DISLOCATION
Splint in extension

DIP
Dorsal splint
Full extension

Question 3

DOCUMENTATION

Answer 3

DOCUMENT:
sensory, vascular, and motor exam before and after reduction and splinting.

PIP DISLOCATION: CLASSIFICATION
Type I = hyperextension ~ volar plate
Type II = dorsal dislocation ~ volar plate + collateral lig
Type III = Fracture dislocation