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

• 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.

Figure 1 :  Dorsal proximal interphalangeal (PIP) dislocation.

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Figure 7 :  Equipment.

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The full content of this section includes:

• Step-by-step text instructions for performing the procedure
  
• Clinical pearls providing practical clinical tips from medical experts
• Patient safety guidelines consistent with Joint Commission and OHSA standards
• Links to medical evidence and related procedures

Figure 12 :  Dorsal dislocation: Key Steps.

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Figure 13 :  Lateral dislocation: Key Steps.

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Figure 14 :  Volar dislocation: Key Steps.

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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