What is the treatment for a dislocated thumb?

Treatment of a Dislocated Thumb

The treatment of a dislocated thumb requires immediate closed reduction followed by appropriate immobilization, with surgical intervention indicated when closed reduction fails or when there is significant joint instability. 1

Initial Assessment and Management

• Radiography with at least 2 views (PA and lateral) is essential as the initial imaging for suspected thumb dislocation to evaluate displacement and articular involvement 1
• Adding an oblique view increases diagnostic yield for thumb fractures and dislocations 1
• A true lateral radiograph of the carpus is necessary to assess distal radioulnar joint alignment if the dislocation involves the base of the thumb 1

Treatment Algorithm

Closed Reduction

• Attempt closed reduction under appropriate anesthesia (ring block, digital block) as the first-line treatment for all thumb dislocations 2, 3
• Following successful closed reduction, immobilize with a thumb spica cast or splint for 3-6 weeks 4
• Active finger motion exercises should be performed following reduction and immobilization to prevent stiffness, which is one of the most functionally disabling adverse effects 1

Surgical Management

• Open reduction is indicated when:

  • Closed reduction fails (often due to soft tissue interposition such as the volar plate blocking reduction) 2, 3
  • Fracture fragment displacement is greater than 3mm 1
  • More than one-third of the articular surface is involved 1
  • Joint remains unstable after closed reduction 5

• Surgical approaches may include:

  • Dorsal approach - particularly effective when the volar plate is interposed within the joint 2
  • Ligament repair or reconstruction - especially when there is associated ligament avulsion or instability 5, 3
  • Pin fixation may be required to maintain reduction in unstable joints 6

Post-Reduction Management

• Home exercise program is recommended following the immobilization period 1
• Patients should be instructed to move uninvolved fingers regularly through a complete range of motion during the immobilization period to prevent stiffness 1
• Follow-up should monitor for:
  • Pain relief 1
  • Restoration of function 1
  • Joint stability 5
  • Range of motion 3

Complications and Special Considerations

• Unremitting pain during follow-up requires reevaluation for potential complications 1
• Delayed presentation (>1 week) often requires open reduction as closed reduction is likely to fail 2
• For chronic dislocations, more extensive surgical intervention including ligament reconstruction may be necessary 5, 6
• Hand stiffness is a major functional complication that can be minimized with appropriate early motion exercises 1

Long-term Considerations

• For thumb base dislocations that develop osteoarthritis, orthoses should be considered for symptom relief 4
• Surgery (interposition arthroplasty, osteotomy, arthrodesis) should be considered for severe thumb base osteoarthritis when conservative treatments have failed 1, 4