From the Guidelines
For a small finger dislocation at the distal interphalangeal (DIP) joint, immediate reduction followed by splinting is recommended. This approach is crucial in minimizing morbidity, mortality, and improving quality of life by preventing chronic instability or deformity. The reduction process should be gentle, applying traction to the fingertip while pushing the dislocated joint back into place, and then the finger should be splinted in a slightly flexed position using a stack or aluminum splint for 3-4 weeks 1.
Key Considerations
- Apply ice and elevate the finger to reduce swelling before and after reduction.
- Use ibuprofen 400-600mg every 6-8 hours or acetaminophen 500-1000mg every 6 hours for pain and inflammation management.
- The finger should be immobilized continuously for the first 1-2 weeks, then at night and during activities for an additional 2 weeks to ensure proper healing.
- Gentle range of motion exercises can begin after 2 weeks if pain allows, promoting recovery and preventing stiffness.
- It is essential to seek immediate medical attention if reduction cannot be achieved, if there's an open wound, or if there are signs of neurovascular compromise such as numbness or discoloration 1.
Diagnostic Imaging
While the initial management involves clinical assessment and reduction, understanding the role of imaging is vital. Radiographs are typically used to detect fracture fragments, especially in cases of suspected osseous "mallet" injuries, which include bony avulsion at the insertion of the extensor mechanism of the finger to the distal interphalangeal joint 1. For soft tissue injuries, including tendon and ligament injuries, MRI is ideal for evaluation and surgical planning, offering detailed insights into the extent of the injury 1.
Importance of Proper Management
DIP dislocations often involve damage to the extensor tendon or volar plate, making proper immobilization and follow-up crucial for healing and preventing long-term complications. The management strategy should prioritize minimizing morbidity and mortality while enhancing the quality of life for the patient, focusing on timely and appropriate intervention based on the severity and nature of the injury.