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Dorsal PIP DislocationAka: Dorsal Proximal Interphalangeal Joint Dislocation, Finger Dislocation at Dorsal PIP Joint

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  1. See Also
    1. IP Joint Dislocation
  2. Epidemiology
    1. Most common finger dislocation
  3. Mechanism
    1. Occurs due to blow to end of finger
  4. Complications
    1. Volar plate Fracture is commonly present
      1. Surgery needed if involves >33% of joint surface
  5. Management: Reduction in clinical setting
    1. Digital Nerve Block if >1 hour since dislocation
    2. Maneuver (usually effective)
      1. Hand 1: Hold proximal phalanx to stabilize
      2. Hand 2: Hold middle phalanx for traction/pressure
        1. Apply distal traction
        2. Volar directed pressure at middle phalanx base
        3. Deformity obviously reduces with maneuver
    3. Additional measures if refractory to above
      1. Hyperextend distal part and retry maneuver above
      2. Difficult reduction suggests interposed tissue
  6. Management: Reduction on sideline
    1. Reduce with maneuver above
      1. May forego finger XRay prior to reduction
      2. Digital Block not needed if <1 hour from injury
    2. Criteria for completing game
      1. Affected finger splinted with buddy tape and
      2. Straight-forward reduction and
      3. Stable joint assessment (see above)
    3. Follow-up in clinic
      1. Requires clinical assessment and
      2. Finger XRay
  7. Management: Post-reduction
    1. Joint evaluation post-reduction
      1. Assess joint range of motion
      2. Assess collateral ligaments with PIP flexed
      3. Assess volar plate by hyperextending joint
      4. Extend flexed pip against resistance
        1. Inability suggests central slip disruption
        2. Refer abnormals to orthopedics (Boutonniere risk)
    2. Immobilization
      1. Immobilize for 3 weeks in 20-30 degrees of flexion
        1. Splint for 3 weeks or
        2. Buddy tape finger for 3 to 6 weeks
    3. Follow-up
      1. Repeat XRay and evaluation in one week
    4. Orthopedic referral indications
      1. Unable to relocate joint despite above maneuvers
      2. Avulsion Fracture involving more than 1/3 of joint

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