Follow-Up and Early Management After Finger Dislocation
After a finger dislocation, initiate immediate active range-of-motion exercises for all uninvolved joints while maintaining appropriate splinting of the injured joint, with clinical reassessment at 10-14 days to evaluate for malrotation, loss of reduction, or persistent pain. 1
Immediate Post-Reduction Management
Splinting Protocol by Joint Location
Dorsal PIP joint dislocations require buddy splinting in slight flexion with an extension-block splint after reduction 2. The American Academy of Orthopaedic Surgeons emphasizes that early controlled mobilization with figure-of-eight splinting yields superior range of motion outcomes compared to complete immobilization 3.
Volar PIP joint dislocations need splinting in full extension for 4-6 weeks 2.
DIP joint dislocations require:
- Full extension splinting for volar dislocations 2
- 15-30 degrees of flexion for dorsal dislocations 2
- Duration: 2-3 weeks 2
Metacarpophalangeal joint dislocations are managed with reduction and splinting, though orthopedic referral is required if reduction is not easily achieved 2.
Critical Early Motion Protocol
Begin active finger motion exercises immediately following diagnosis for all uninvolved joints 4, 5, 1. This is non-negotiable because hand stiffness is the most functionally disabling complication following finger injuries 4, 5.
- Finger motion does not adversely affect adequately stabilized fractures regarding reduction or healing 4, 5, 1
- Instruct patients to move fingers regularly through complete range of motion 4, 5
- A home exercise program is effective after immobilization 4, 5
- Failure to encourage early motion leads to significant stiffness that becomes difficult to treat after healing 4
Follow-Up Schedule and Assessment Points
First Follow-Up (10-14 Days Post-Injury)
Obtain repeat radiographs at 10-14 days to ensure fracture position is maintained 1. This timing is critical because you're still within the window for non-operative correction if problems are detected early 1.
Assess for malrotation by examining finger alignment during active flexion:
- Have the patient actively flex all fingers together into a fist 1
- Observe whether fingernails align in parallel planes 1
- All fingers should point toward the scaphoid tubercle without crossing over adjacent digits 1
- Look for scissoring where the injured finger crosses over or under adjacent fingers—this is the hallmark sign of rotational malalignment 1
- Compare the cascade of fingers to the contralateral hand 1
Ongoing Monitoring (3-6 Weeks)
Continue rigid immobilization for 3-6 weeks for stable injuries 4, 5, 2.
Monitor for these specific complications:
- Proper fracture healing 4
- Restoration of finger function 4
- Development of stiffness 4
- Persistent or worsening pain 4, 1
Red Flags Requiring Immediate Reevaluation
Any degree of persistent or worsening pain during the first few weeks demands immediate reassessment for malrotation or loss of reduction 4, 1. This is not optional—unremitting pain indicates complications 4.
Inability to achieve full active flexion without finger overlap suggests rotational malalignment requiring correction 1.
Displacement >3mm or articular involvement >1/3 of joint surface warrants surgical consultation 4, 5.
Common Pitfalls to Avoid
The single biggest mistake is failing to encourage early finger motion, which leads to debilitating stiffness that becomes extremely difficult to treat after fracture healing 4. This cannot be overstated.
Overlooking malrotation during early follow-up leads to poor functional outcomes 1. You must actively assess for this at the 10-14 day mark, not wait until the patient complains.
Complete immobilization of uninvolved joints is outdated practice—these joints should be moving immediately 1, 3.