Dislocation Reduction of the PIP and DIP Joints (Emergency Medicine)

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  • Acute dislocations of the PIP or DIP joints of the fingers and IP joint of the thumb.
  • Open fracture-dislocations require operative irrigation and débridement.
  • Subacute or chronic dislocations require consultation with a hand specialist because reduction is best achieved in the operating room.
  • For a digital block: skin-cleansing agent, 25-gauge 1.5-inch needle, 5-mL syringe, 1% lidocaine without epinephrine
  • For splinting: aluminum-foam finger splint, tape
  • Primary stability of the IP joints is derived from the articular contours of the phalanges and the “ligament box.”
  • Secondary stability is provided by the tendons and their associated retinacula.

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  • Obtain post-reduction radiographs
  • Immobilize the joint with an aluminum-foam splint (20 to 30 degrees of flexion for dorsal and lateral dislocations, full extension for volar dislocations).
  • Arrange for follow-up with a hand specialist (3 weeks for simple, uncomplicated dislocations).
  • Instability of the reduced joint
  • Irreducible dislocation
  • Flexion contracture and joint stiffness
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