Irreducible dorsal dislocation of the distal interphalangeal joint: case report and literature review

Open dorsal distal interphalangeal joint dislocations: A report of 20 cases

INTRODUCTION

Several isolated closed dislocations of the dorsal interphalangeal joint are reported, and sometimes they may be associated with other fractures/dislocations. Less is known about the open dorsal dislocation of the distal interphalangeal joint.

HYPOTHESIS

Open dorsal dislocations are stable after reduction and prone to develop dorsal interphalangeal joint stiffness.

METHODS

Twenty patients with open dorsal dislocation were treated by open reduction and volar plate repair. The diagnosis was made, and the displacement was noted. Associated injuries, fractures, and dislocations were also reported. Postoperative x-rays, range of movements, visual analog score, return to work, and functional outcomes were analyzed.

RESULTS

The average follow-up was 23months (range: 19-27months). There were dorso-radial (n=13), dorsal (n=5) and dorso-ulnar (n=2) dislocations. Follow-up with radiographs showed good reduction and congruent distal interphalangeal joint. The mean range of DIP joint movement was 53% (range: 40-65%) and grip strength 70% (range: 50-76%) of the opposite side. The Median VAS score was 0.6 (range: 0-2). Seventeen out of 20 patients who were operated on<8hours of injury had a significant impact on the functional outcome (p<0.05). Three patients who had treatment delay>8hours of injury developed significant postoperative joint stiffness.

DISCUSSION

Adequate debridement and an early open reduction of the dorsal interphalangeal joint dislocation produces stable and congruent joint with good functional outcome and early return to normal activities. Open dislocations do not behave like closed dislocations, and joint stiffness is more common and inevitable.

LEVEL OF EVIDENCE

IV; retrospective case study.

Phalanx fractures and dislocations in athletes

PURPOSE OF REVIEW

Phalangeal fractures, dislocations, and fracture-dislocations in the hand are common injuries. We review the current literature on the diagnosis and treatment of these injuries in the athlete. An understanding of the anatomy and its relationship to the mechanism of injury may help to direct appropriate management. Return to play remains an important concern to the patient-athlete.

RECENT FINDINGS

Findings from recently published articles reinforce previously established treatment methods in the management of finger phalangeal fractures, dislocations, and fracture-dislocations. The majority of these injuries can be treated non-operatively. Technological advances in implant designs may conceivably allow for earlier rehabilitation and, in turn, a more expeditious return to sport. Management of phalangeal injuries in the elite athlete often necessitates special treatment considerations. The majority of phalangeal bone and joint injuries in the athlete can be treated in a comparable manner to the non-athlete. The goals of treatment are restoration of bone and joint alignment and stability in order to hasten a return to competition. Surgery as a means to expedite return to play in the high-level athlete should be determined on a case by case basis. Technological improvements in surgical implants may enable accelerated postoperative recovery. However, to our knowledge, there are no published studies to definitively support this assumption.

Irreducible dislocation of the thumb interphalangeal joint due to displaced flexor pollicis longus tendon: case report and new reduction technique

Dislocation of the thumb interphalangeal (IP) joint is uncommon because of the inherent stability of the joint. Cases in which reduction was blocked by the volar plate, the flexor pollicis longus (FPL) tendon, the sesamoid bone, and an osteochondral fragment have been described in the literature. This article reports a case of closed thumb IP joint dislocation caused by the displacement of the FPL tendon. A new percutaneous reduction technique for this injury will also be presented. A 63-year-old woman presented to the emergency room with an obvious thumb deformity. Radiographs confirmed dorsal dislocation of the thumb IP joint without associated fracture. Closed reduction was not successful. Percutaneous reduction was performed under locoregional anesthesia, because the dislocation was due to an FPL tendon that had displaced dorsally and radially to the proximal phalanx. After reduction, Kirschner wire fixation was not needed, but IP joint immobilization with a splint was required for 3 weeks. Postoperatively, there were no complications in soft tissues and the operative scar was almost unrecognizable. This technique enables a mini-invasive reduction by operating percutaneously on the FPL. In addition, unlike with a volar zigzag approach, it is possible to suppress the occurrence of postoperative adhesion of the flexor tendon. This new minimally invasive reduction technique is useful for irreducible dislocation of the thumb IP joint due to a displaced FPL tendon.

Irreducible Distal Interphalangeal Joint Dislocation

We present a case of an irreducible dorsal distal interphalangeal joint dislocation caused by dislocation of the flexor digitorum profundus tendon. Although these types of injuries are rare, through a search of the literature, we conclude that a high degree of suspicion must be maintained in irreducible dislocations for this type of injury. An early open approach for diagnosis and treatment is recommended.