DIP Dislocation

Ovid: 5-Minute Sports Medicine Consult, The

DIP Dislocation
Jason J. Stacy
Jeffrey McDaniel
  • Dislocations of distal interphalangeal (DIP) or 1st interphalangeal (IP) joints
  • Mechanism is typically a hyperextension injury of the DIP joint.
  • Synonym(s): Jammed finger
  • Pure DIP dislocations are uncommon. They are usually accompanied by a bony avulsion fracture.
  • Most dislocations are primarily dorsal in direction.
  • Volar dislocations are often associated with disruption of the terminal extensor tendon at its insertion point, making management more difficult.
  • Simultaneous DIP and proximal interphalangeal (PIP) dislocations are rare, occurring most commonly in ring and small fingers.
  • Mechanism of injury (ie, hyperextension)
  • Presence of an obvious deformity (eg, distal phalanx positioned above or below the plane of the middle phalanx)
  • Often self-reduced by the patient on the playing field
Physical Exam
  • Obvious deformity if not already reduced: Distal phalanx sitting above (dorsal dislocation) or below (volar dislocation) the plane of the middle phalanx.
  • Careful examination: Check flexor and extensor function (with the PIP joint held in extension) of the DIP joint and sensation at the tip of the finger.
  • Check collateral ligament: Place radial and ulnar stress across DIP joint with joint in full extension and 30 degrees flexion looking for increased laxity.
  • Check volar plate: Increased hyperextension of the joint is indicative of a volar plate injury.
Diagnostic Tests & Interpretation
  • Radiographs: 3 views preferred (anteroposterior, lateral, and oblique views)
  • Look carefully for any bony avulsion, especially of the volar plate.
Differential Diagnosis
  • Fracture of distal or middle phalanx
  • Flexor digitorum profundus (FDP) rupture (ie, jersey finger)
  • Extensor mechanism rupture (ie, mallet finger)
  • Bony mallet finger (bony avulsion of the insertion of the extensor mechanism at the dorsal base of the distal phalanx)
  • Fracture-dislocation
  • Collateral ligament disruption
  • Chronic instability
834.02 Closed dislocation of interphalangeal (joint), hand

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