Simultaneous Dorsal Dislocation of the Proximal and Distal Interphalangeal Joints in the Middle Finger: A Case Report

Abstract

Introduction: Dorsal dislocation of a proximal or distal interphalangeal joint is a common clinical problem. However, simultaneous dislocation of both joints in the same digit is rare. Case Presentation: A 32-year-old male injured his left hand third finger while biking. Examination revealed a stepladder deformity. Neurovascular examination was normal. Radiographs revealed dorsal dislocation of both the proximal and distal interphalangeal joints. The finger was reduced easily by longitudinal manual traction under the digital block. The finger was splinted in the intrinsic plus position for 3 weeks accompanied with active range of motion. After 6 months, the patient returned to normal sporting activity without limitation of motion. Conclusions: In case of simultaneous dorsal dislocation of a proximal and distal interphalangeal joint, closed reduction is the treatment of choice and it could result in good and normal range of motion.

Double Interphalangeal Joint Dislocation of the Finger in Adolescent Athletes: A Review of Two Cases and the Relevant Literature

“…The increased mobility, the lack of protection from the surrounding fingers, and the weakness of the articular capsule and collateral liga-ments of the interphalangeal joints may be posed as logical explanations [2]. All the information gained about the mechanism of this injury is related to be a traumatic hyperextension [10,11]. Firstly, an axial compression force to the tip of the finger results in an excessive hyperextension at the DIP joint, 3 Case Reports in Orthopedics causing injury of the volar articular capsule and allowing dorsal dislocation of the DIP joint.…”

“…Sports activities, such as basketball, football, and softball, are by far the commonest cause of injury. Falls is the second common reason implicated in some of the cases, followed by work-related injuries ( Table 1 ) [ 7 – 10 ]. A classic “step-ladder” deformity of the affected finger will be obvious, and the diagnosis confirmed with a plain radiograph [ 3 ].…”

“…All the information gained about the mechanism of this injury is related to be a traumatic hyperextension [ 10 , 11 ]. Firstly, an axial compression force to the tip of the finger results in an excessive hyperextension at the DIP joint, causing injury of the volar articular capsule and allowing dorsal dislocation of the DIP joint.…”

“…Thus, it is obvious that it is not a “simultaneous” dislocation, but two separate actions that occur in a quick succession and result to this double dislocation of both distal and proximal joints. Also, this type of injury may be accompanied with avulsion fracture of the volar side of the base middle phalanx [ 10 , 12 ] and rupture of the central slip of the extensor tendon [ 5 ]. In our cases, there were not any accompanying avulsion fractures or tendon injuries.…”

“…In most dislocations, closed reduction is the treatment of choice if there is not interposition of periarticular soft tissues that prohibits this action and can be easily achieved by longitudinal traction and pressure on the dislocated base of the phalanx, with [ 2 , 6 , 13 ] or without anesthesia [ 4 , 8 ]. However, patients with neglected injuries, open dislocations, ligamentous injuries, and associated fractures or flexor tendon injuries were not so fortunate, especially in cases where larger defects involving more than 50% of the articular surface may have worse outcomes after conservative treatment and may be better treated with fragment surgical fixation in order to stabilize the joint and avoid limitations of the range of motion [ 9 , 10 ]. Static stabilizers, such as collateral ligaments, are the main stabilizers of the DIP and PIP joints.…”