Treatment of Dorsal Dislocation of DIP Joint After Closed Reduction
After successful closed reduction of a dorsal dislocation of the distal interphalangeal (DIP) joint, the recommended treatment is extension block splinting followed by early active motion exercises within the constraints of stable fixation.1
Immobilization Protocol
- Apply an extension block splint that prevents hyperextension while allowing controlled flexion
- Immobilization period should typically last 3-4 weeks 1
- The splint should be positioned to maintain proper alignment of the DIP joint while preventing recurrent dorsal displacement
- For unstable reductions, consider supplementary buddy taping to an adjacent finger for additional support
Rehabilitation Protocol
Early active motion exercises:
- Begin active finger motion exercises immediately after splinting to prevent stiffness 1
- Perform gentle active flexion exercises within the constraints of the extension block splint
- Avoid passive extension during the initial healing phase to prevent redislocation
Progressive rehabilitation after immobilization:
Monitoring and Follow-up
- Obtain follow-up radiographs at 1-2 weeks to ensure maintained reduction
- All patients with unremitting pain during follow-up should be reevaluated for potential complications 2
- Monitor for signs of joint instability, which may indicate ligamentous injury requiring additional treatment
Special Considerations
For Irreducible Dislocations
If closed reduction fails, open reduction may be necessary. Common causes of irreducibility include:
- Volar plate interposition
- Entrapment of flexor digitorum profundus tendon
- Buttonholing of the middle phalanx through soft tissues 3
For Fracture-Dislocations
- Fracture-dislocations with significant articular involvement (>40%) or unstable reductions may require surgical fixation 4
- Open reduction and internal fixation using low-profile mini-plates has shown excellent outcomes with early motion protocols 4
Complications to Monitor
- Joint stiffness (most common complication)
- Chronic pain
- Recurrent instability
- Post-traumatic arthritis
- Extensor lag (inability to fully extend)
Evidence-Based Outcomes
Early active motion protocols have demonstrated superior outcomes compared to static splinting in terms of:
- Better range of motion preservation
- Improved pinch power
- Earlier return to function 5
In one study, patients treated with early active motion after buddy taping showed excellent functional outcomes with only subtle limitations in end-range movement at 4-month follow-up 6.
The evidence strongly supports that active finger motion exercises are crucial for preventing stiffness, which is one of the most functionally disabling adverse effects following distal phalangeal injuries 2, 1.