Does a successfully reduced finger dislocation without a fracture in an adult or adolescent require splinting?

Splinting After Successful Finger Dislocation Reduction

Yes, splinting is required after successfully reducing a finger dislocation without fracture, with the specific type and duration depending on which joint was dislocated.

Proximal Interphalangeal (PIP) Joint Dislocations

Dorsal PIP Dislocations (Most Common)

• Buddy tape the affected finger to an adjacent finger in slight flexion (20-30 degrees) with an extension-block splint 1
• The extension-block splint prevents full extension while allowing protected flexion, which is the classic treatment for dorsal PIP dislocations 2
• Continue buddy splinting for 3-4 weeks with early protected motion 1, 3
• This approach allows early active motion while preventing re-dislocation 2

Volar PIP Dislocations (Less Common)

• Splint in full extension for 4-6 weeks 1
• These injuries are more unstable than dorsal dislocations and require strict immobilization 1
• Do not allow flexion during the immobilization period 1

Distal Interphalangeal (DIP) Joint Dislocations

Volar DIP Dislocations

• Splint in full extension for 2-3 weeks 1

Dorsal DIP Dislocations

• Splint in 15-30 degrees of flexion for 2-3 weeks 1

Metacarpophalangeal (MCP) Joint Dislocations

Dorsal MCP Dislocations

• Reduce and splint after successful closed reduction 1
• If the dislocation is not easily reduced, immediate referral to orthopedic surgery is required as this may represent a complex dislocation requiring open reduction 1, 4

Volar MCP Dislocations

• These are rare and warrant immediate orthopedic referral regardless of reduction success 1

Critical Principles

Early protected motion is essential - Begin active motion exercises for unaffected joints immediately to prevent stiffness, which is one of the most functionally disabling complications 5, 6

Radiographic confirmation is mandatory - Obtain three-view radiographs (PA, lateral, and oblique) both before and after reduction to rule out associated fractures and confirm adequate reduction 5, 1

Common Pitfalls to Avoid

• Never leave a reduced dislocation unsplinted - Even "stable" reductions require immobilization to allow ligamentous healing 1, 4
• Avoid over-immobilization of unaffected joints - Only immobilize the injured joint; allow motion at adjacent joints to prevent stiffness 5
• Do not assume stability without imaging - Small avulsion fractures are commonly missed without proper radiographs and change management 1, 4
• Inadequate immobilization duration leads to chronic instability - Follow the specific timeframes for each joint type 1, 3