Double Dislocation of the Interphalangeal Joints of the Little Finger

High-energy traumas may lead to the dislocation of joints with or without fractures. However, simultaneous double dislocation of the proximal and distal interphalangeal joints (PIP and DIP) in fingers shows up rarely. Although it can be inferred as simultaneous dislocation occurring during the same trauma, consecutive events should be taken into consideration. A 29-year-old, right-hand dominant male patient presented to the emergency room with a left little finger deformity after being hit by a ball while playing football. Despite the inability to move the little afteruent to this hyperextension injury, there was mild swelling, ecchymosis, and pain with no trace of laceration or neurovascular injury. PIP and DIP joint dislocations of the left-hand little finger with distal phalanx proximal fracture were detected on the radiograph indicating a stepladder deformity. Closed reduction was achieved by longitudinal traction and applying pressure over the base of the dislocated digit. Afterward, an aluminum finger splint was applied to the little finger in the functional position to prevent further damage. Re-evaluation radiographs revealed a successful reduction of both joints. Immobilization via an aluminum finger splint was recommended for three weeks. Subsequently, range of motion exercises and rehabilitation were started. Three-month follow-up revealed an almost full range of motion in both PIP and DIP joints without stiffness and pain. Although double dislocation seems to present with more painful and swollen fingers than single dislocations, it can also present with mild pain and swelling, as in this case. The little finger is easily exposed to traumas due to the lack of surrounding tissue. Therefore, double dislocation is mostly seen in the little finger. This case report briefly illustrates a rare incidence of double dislocation involving both the PIP and DIP joints of the little finger. Normal range of motion of both joints was reached by early reduction followed by timely rehabilitation.

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.

Double Dislocation of Interphalangeal Joints Accompanied with Contralateral Shoulder Dislocation: A Case Report

Dislocation of any joint is an orthopaedic emergency and needs immediate attention by the attending physician. A delay in reducing a dislocated joint can lead to disastrous complications both immediately as well as in the long run. Although anterior dislocation of a shoulder joint is by far the commonest dislocation encountered by any emergency care physician, other joints may also get dislocated. In certain cases two joints may get dislocated simultaneously. Such dislocation is known as a double dislocation. Double dislocation of the proximal interphalangeal joint and the distal interphalangeal joint in the same finger is a rare injury. High impact loading at the fingertip is the primary cause in most cases and it is often associated with younger individuals playing contact sports. The right little finger is the digit commonly involved and this injury is evident in football players more often than not. Although closed reduction is a preferred treatment, it may not be always successful. Time of presentation, tendon interposition, associated swelling and co-existent phalangeal fractures are certain key impediments to a successful closed reduction manoeuvre. In patients with an open injury, a thorough wash out and appropriate antibiotic cover is mandatory. We report a rare case of double dislocation of the interphalangeal joints accompanied with contralateral shoulder dislocation in an elderly man sustained after a fall which was treated successfully with closed reduction and early mobilization.