JAMES R. BORCHERS, MD, MPH E THOMAS M. BEST, MD, PhD
A more recent article oncommon finger fractures and dislocationsis available.
I'm a family doctor.2012;85(8):805-810
Related letter: Proper technique to reduce metacarpophalangeal dislocations
Author Disclosure: No relevant financial affiliations to disclose.
Finger fractures and dislocations are common injuries that are often treated by primary care physicians. A systematic physical examination is essential to avoid complications and poor outcomes after these injuries. Radiographs (usually anteroposterior, true lateral, and oblique views) are required when evaluating finger fractures and dislocations. Dorsal dislocation of the proximal interphalangeal joint is the most common type of finger dislocation. Finger dislocations should be reduced as soon as possible and associated soft tissue injuries treated appropriately. Referral to a hand specialist is necessary when a dislocation cannot be reduced; it is unstable after reduction; or involves significant ligament, tendon, or soft tissue injury. Some common finger fractures can be treated conservatively with appropriate reduction and immobilization. Referral to a hand specialist is necessary when a fracture is unstable, involves a large portion (greater than 30 percent) of the intra-articular surface, or has significant rotation.
Finger fractures and dislocations can occur during everyday activities such as work, but most commonly occur while participating in athletic activities. Finger and metacarpal fractures are the most common sports fractures in adults and adolescents.1,2If not treated properly, finger fractures and dislocations can have significant consequences, including dysfunction, chronic pain, stiffness, and deformity.3The goal of treatment is the return to normal function and activity. Proper referral to a hand surgeon can avoid delays in necessary treatment.table 1summarizes the evaluation and treatment of finger dislocations and fractures.
|Clinical recommendation||evidence evaluation||references|
|Finger fractures involving more than 30% of the intra-articular surface should be referred to an orthopedist or hand surgeon.||C||9,16,17|
|After reduction of a proximal interphalangeal dislocation, a brief flexion splint with early active mobility and strengthening is preferred over prolonged immobilization.||B||5,10|
|Treatment of a mallet fracture includes immobilizing the distal interphalangeal joint in extension; different types of rails are equally beneficial.||B||13–15|
|Displaced, oblique, or spiral finger fractures should be referred to a hand surgeon.||C||3|
|To diagnose||Initial examination and treatment||Management||Reference recommendations|
|PIP Compensation||Fractures involving more than 30 to 40 percent of the intra-articular surface, reduction is difficult or unsuccessful, patient is unable to achieve full extension after reduction|
|MCP dislocation (especially in the thumb)||Reduction requiring anesthesia, open reduction|
|dip offset||complicated injuries|
|Terminal fracture (tuft fracture)||rarely needed|
|Hammerbruch||Conservative treatment is ineffective; large displaced bone fragment or significant volar subluxation|
|Avulsion fracture of flexor digitorum profundus||all injuries|
|Fracture of the middle or proximal phalanx||Displaced, oblique, or spiral fractures|
General approach to finger injuries
History should include mechanism of injury, timing and progression of symptoms, hand control, and any previous finger injuries. A physical exam is critical in evaluating finger injuries. Common signs of injury include local swelling, erythema, pain, deformity, and tenderness to palpation. Assessment should also include finger alignment, ligament integrity, neurovascular status, and joint flexion and extension. Stability assessment is necessary for proper management of dislocated joints.
A systematic approach to finger examination avoids missed diagnoses, potential complications, and poor outcomes. If a fracture or dislocation is suspected, radiographic examination with at least three views (usually anteroposterior, true lateral, and oblique) is required.4
Treatment of finger injuries begins with closed reduction of the fracture or dislocation, if indicated. The stability of the reduction is assessed by gentle active flexion of the affected finger; the joint must be stable in flexion and extension. Rotation is evaluated after an active flexion fracture of the finger; there should be no digital overlap. All nails should point to the tip of the thumb. Stabilization is often achieved by immobilization. Post-reduction radiography can be used to assess alignment. Significant instability or rotation requires referral to a hand surgeon.
Finger dislocations can occur at the distal interphalangeal (DIP), proximal interphalangeal (PIP) or metacarpophalangeal (MCP) joints. The PIP joint is the most commonly dislocated finger joint.5MCP joint injuries usually occur in the thumb.6DIP joint dislocations are often traumatic and often complicated by fractures and soft tissue injuries.7
The PIP joints are primarily stabilized by the appropriate phalangeal joint surfaces, in addition to supporting soft tissue structures, including the collateral ligaments and volar plates. Dislocations are described as dorsal, volar, or lateral, depending on the direction from the medial phalanx to the phalanx.
A dorsal PIP dislocation is the most common type of finger dislocation. It usually involves injury to the volar plate and may involve an avulsion fracture of the volar plate. Dorsal displacement of the PIP usually results in apparent dorsal deformity of the middle phalanx and volar plate tenderness. If the joint cannot be reduced or if the joint remains unstable after reduction and then dislocates again, the injured finger should be evaluated radiologically. X-rays also help identify a volar fracture of the middle phalanx and other associated injuries.
Reduction of a dorsal PIP dislocation should be attempted at the time of injury, if possible by traction and volar pressure on the median phalanx at the PIP joint(illustration 1). Successful reduction results in immediate relief of symptoms and resolution of the deformity. Reduction is usually successful without anesthesia. A local joint lock may be considered if severe pain is preventing reduction. The possibility of concomitant fracture or soft tissue injury should be considered, particularly if replacement is unsuccessful. An X-ray should be taken before further reduction attempts are made.
After successful reduction, a radiograph is also required to assess for subluxation, instability of the PIP joint, and possible fractures of the volar plate of the middle phalanx. Volar plate fractures can be small and can be treated conservatively. The risk of subluxation and instability is greater with larger palmar plate fractures.8Referral to a hand specialist is indicated when more than 30% of the intra-articular volar surface is affected or when subluxation or instability of the PIP joint is observed.9Flexion and extension at the PIP joint should be assessed after successful reduction of a dislocation. If severe loss of motion persists, referral is recommended. Inadequate treatment of PIP dislocations can lead to chronic pain, degenerative changes and loss of function.
Traditional treatment after reduction of uncomplicated dorsal PIP joint dislocations is immobilization for one to two weeks, followed by taping for an additional one to two weeks. The benefits of early range of motion after reduction of a dorsal PIP dislocation are discussed. One study showed an increase in range of motion and intrinsic muscle strength after four weeks of immobilization with daily active exercise compared to immobilization alone.10For uncomplicated dorsal PIP dislocations, a brief flexion splint with early active mobility and strengthening is preferred over immobilization.5,10
PIP lateral and volar dislocations are less common than back injuries. a volar dislocation(Figure 2)may be accompanied by avulsion of the central sliding extensor mechanism of the PIP. A central slip injury can result in loss of finger extension at the PIP joint and, over time, hyperflexion or boutonniere deformity.11These injuries should be immobilized in full PIP extension for six weeks to avoid chronic PIP joint deformities.11PIP volar dislocations are more difficult to reduce and results should be confirmed with a post-reduction radiograph. Referral is recommended for fractures involving more than 30 to 40 percent of the intra-articular surface when reduction is difficult or unsuccessful, or when the patient is unable to achieve full extension after reduction.
Dislocations of the MCP joint are usually dorsal.6Simple dislocations do not involve any soft tissue structure and are reduced using the same technique as dorsal PIP dislocations. Reduction may be unsuccessful due to soft tissue injury or fracture. For reductions requiring anesthesia and for open reductions, radiography and referral is recommended.7After a simple MCP reduction, an X-ray is required to assess joint congruence. Treatment consists of immobilization in slight flexion with early mobility and strengthening exercises.
DIP joint dislocations are often associated with trauma and may be associated with fractures and soft tissue injuries.7A simple dorsal DIP dislocation should be evaluated with radiographs to assess for a fracture. The reduction is similar to that of a dorsal PIP dislocation when there is no concomitant injury. Treatment after a simple reduction is also similar to that of a PIP dislocation. For complicated injuries, referral is recommended.
Several types of fractures can affect the phalanx or the intra-articular surface. If these fractures are not recognized and treated properly, long-term disability and disability can result.
Fractures of the distal phalanx
tuft break(Figure 3)It is the most common form of terminal fracture. This fingertip fracture is often associated with a crush injury. Terminal fractures are stable and can only be treated with simple splinting of the DIP joint. After two to four weeks of immobilization, there should be mobility and strengthening of the DIP joint. Any soft tissue and nail bed injuries associated with these fractures must be recognized and treated. Patients should be informed that these fractures are often complicated by hyperesthesia, pain, and numbness for up to six months after the injury.12
Hammer fractures (hammer fingers) occur when inserting the terminal finger extension mechanism into the dorsal portion of the distal phalanx. These fractures are caused by axial loading of a stretched fingertip, resulting in forced flexion at the DIP joint.11A hammer fracture involves a bone fragment attached to the terminal extensor mechanism(Figure 4).
Treatment of a mallet fracture involves immobilizing the DIP joint in extension for eight weeks. It is imperative that extension is maintained at all times during treatment, as any flexion can impair healing and prolong treatment time. After applying the splint, a radiograph should be taken to confirm the congruence of the fracture fragment with the terminal phalanx in the joint space.3Studies show no differences in outcomes between plate types as long as DIP length is maintained.13–15
Referral for surgical treatment of mallet fractures has been suggested for those involving more than 30% of the intra-articular surface and those associated with volar subluxation of the distal phalanx.16,17Still, a study of 22 mallet fractures involving more than 30 percent of the joint space found that patients with volar subluxation and fragments displaced after immobilization showed no difference in pain and function than patients without these features.18Conservative therapy for all mallet fractures is preferable as first-line treatment and may produce results similar to surgical treatment.19,20Consultation with a hand surgeon is recommended when the physician is dissatisfied with the treatment of more complicated malleus fractures.
DIGITAL AVULSION FRACTURE OF THE PROFOUND FLEXOR
The flexor digitorum profundus tendon attaches to the volar surface of the distal phalanx. An avulsion fracture(Figure 5)it usually arises from forced hyperextension of a flexed IFF joint. This injury is commonly known as Jersey finger.11Examination of the affected finger reveals an inability to flex the finger at the DIP joint. Due to the risk of tendon retraction and the need for surgical treatment, patients with avulsion fractures of the flexor digitorum profundus should be referred to a hand specialist.
MIDDLE AND PROXIMAL PHALANX FRACTURES
Fractures of the middle and proximal phalanx are often associated with trauma. These lesions should be suspected on examination of the middle or proximal phalanx with gross deformity. These fractures are generally classified as intra- or extra-articular. Intra-articular fractures are often complicated and unstable and should be referred to a hand specialist.3Extra-articular fractures can be non-displaced or displaced. Stable, non-displaced fractures can be managed conservatively with tape and early range of motion, but must be carefully monitored to ensure fracture stability. Displaced, oblique, or spiral fractures are inherently unstable and should be referred to a hand specialist.3
It's usually caused by a sudden impact from a blow, fall or other trauma. You can dislocate almost any joint in your body— your ankles, knees, shoulders, hips, elbows or jaw. You can even dislocate your finger and toe joints. When more pressure is put on a bone than it can stand, the bone may split or break.What is the most common finger dislocation? ›
A dorsal PIP dislocation is the most common type of finger dislocation. It usually involves injury to the volar plate and may include a volar plate avulsion fracture.What causes dislocation of fingers? ›
A direct blow to the hand, fingers, or thumb may cause a dislocation. Falls and contact sports, such as baseball and football, are commonly linked to finger dislocations. Other factors may contribute to a finger dislocation such as: previous injuries that have damaged the bone or soft tissues (ligaments)Which joint is the most commonly associated with a jammed finger and finger dislocations? ›
The foremost common joint to be dislocated is the proximal interphalangeal joint (PIPJ) of the middle joint in the finger.Why do my bones keep dislocating? ›
Symptoms and Causes
Trauma that forces a joint out of place causes a dislocation. Car accidents, falls, and contact sports such as football are common causes of this injury. Dislocations also occur during regular activities when the muscles and tendons surrounding the joint are weak.
Due to the small steps on the surface of most crystals, stress in some regions on the surface is much larger than the average stress in the lattice. This stress leads to dislocations. The dislocations are then propagated into the lattice in the same manner as in grain boundary initiation.Which finger is easiest to dislocate? ›
Finger dislocation is a common injury. It occurs when the bones of the finger are moved (dislocated) from their normal position. A dislocated finger can occur in any of the joints of any finger, but it occurs most often in the middle knuckle of the little, ring, middle, or index finger.What happens to a dislocated finger long term? ›
But it can take up to six months for your finger to fully heal. In some cases, especially when the dislocation is accompanied by a serious break or medical treatment is not prompt, pain and stiffness can be long lasting or even permanent.How do you strengthen a dislocated finger? ›
- With your good hand, grasp your affected finger. Your thumb will be on the top side of your finger just below the joint that is closest to your fingernail.
- Slowly bend your affected finger only at the joint closest to your fingernail. Hold for about 6 seconds.
- Repeat 8 to 12 times.
You should go immediately to an urgent care or emergency room, where a physician can "reduce" - put the finger back into place - safely. Simple dislocations typically require just buddy tape to a nearby finger. Complicated fractures (need an x-ray) would need immobilization with a splint.
- Chronic stiffness is common after DIP dislocation treatment.
- Overtreatment, such as prolonged splinting and multiple attempts at reduction of volar PIP joint dislocations, increases the likelihood of volar plate scarring and flexion contractures.
- Chronic pain.
- Reduced mobility of MCP, PIP, and DIP joints.
A break (or fracture) in a finger bone results in a crack, which must be set to heal. By contrast, a dislocation is not a break in the bone but a separation of two bones where they meet at a joint. Both fractures and dislocations can be quite painful.How long does it take a dislocated finger to heal? ›
Most injuries like this heal without any problems in about six weeks. You should regain movement quickly with regular exercise (within four weeks). However, it may take several months for your symptoms to settle completely. These can include pain or discomfort, stiffness, decreased strength and swelling.Which finger joints are affected by arthritis? ›
Osteoarthritis most commonly affects the hands, lower back, neck, and weight-bearing joints such as knees, hips, and feet. Osteoarthritis in any of these joints can lead to physical disability. Hands. Osteoarthritis of the hands seems to run in families.What deficiency causes bones to pop? ›
Calcium is needed to make bones strong and a lack of calcium can cause osteomalacia. Because it's fairly easy for most people to get enough calcium from their diet, a lack of calcium is not a common sole cause of osteomalacia. But it's still worth knowing which foods are high in this important nutrient.Which is worse fracture or dislocation? ›
Dislocated joints, unless they are realigned quickly, are more likely to damage blood vessels and nerves than are fractures. Some complications (such as blood vessel and nerve damage and infections) occur during the first hours or days after the injury.What vitamin deficiency causes bones to pop? ›
Low vitamin D levels may lead to clinical manifestations, including bone pain, muscle weakness, falls, low bone mass, and fractures, with subsequent diagnoses of osteomalacia, osteoporosis, and myopathy.Are some people more prone to dislocations? ›
Anyone can dislocate a joint if they fall or experience some other type of trauma. However, older persons tend to have a higher risk, especially if they lack mobility or are less able to prevent falls.What is the most common cause of recurrent dislocation? ›
Bone loss either on the glenoid or the humeral head may cause or complicate recurrent shoulder dislocations. Recurrent episodes of anterior instability of the shoulder joint may cause Hill-Sachs or osseous Bankart lesion get larger which leads further instability[46,47].What is the most common cause of dislocation? ›
The cause is usually trauma resulting from a fall, an auto accident, or a collision during contact or high-speed sports. Dislocation usually involves the body's larger joints. In adults, the most common site of the injury is the shoulder.
When treated early, most dislocations do not cause permanent injury. You should expect that: Injuries to the surrounding tissues generally take 6 to 12 weeks to heal. Sometimes, surgery to repair a ligament that tears when the joint is dislocated is needed.Do you need surgery for a dislocated finger? ›
If the finger dislocation is severe, or if there are fractures or other injuries to the hand, surgery may be necessary to repair the dislocation.What is the fastest way to heal a dislocated finger? ›
Ice the finger for 20 minutes every few hours for a few days, if you are able. Continue elevating your finger when possible. Take pain medication as prescribed by the doctor. Depending on the nature of the injury, surgery or follow-up with an orthopedist who specializes in hands may be needed.Can a chiropractor fix a dislocated finger? ›
How Can Physiotherapy or Chiropractic Help with a Joint Dislocation? While it is not in a physiotherapist or chiropractor's scope of practice to reduce a dislocated joint, both can help you rehabilitate the joint after your injury has occurred.How much is surgery for a dislocated finger? ›
On MDsave, the cost of a Closed Treatment of Hand/Finger Dislocation or Fracture (in office) ranges from $370 to $1174.What are the 3 possible symptoms of dislocation? ›
Signs and symptoms of a dislocation include: Joint is visibly deformed or out of place. Numbness or tingling at the joint. Swollen or discolored.What is the medical term for dislocated finger? ›
Dorsal dislocation: The phalanx closer to the tip of the finger is displaced toward the back of the hand. Volar dislocation: The phalanx closer to the tip of the finger is displaced toward the palm of the hand. Lateral dislocation: The phalanx closer to the tip of the finger is displaced to the side.Is joint dislocation life threatening? ›
Although both kinds of dislocations are serious injuries, a posterior dislocation requires more urgent medical attention. In a posterior dislocation, the vital structures behind the SC joint can be compressed, leading to life-threatening problems with breathing or blood flow. (Top) Normal shoulder anatomy.What are the main causes of fracture? ›
- Fall from a height.
- Motor vehicle accidents.
- Direct blow.
- Child abuse.
- Repetitive forces, such as those caused by running, can cause stress fractures of the foot, ankle, tibia, or hip.
Fractures are usually caused by traumas like falls, car accidents or sports injuries. But some medical conditions and repetitive forces (like running) can increase your risk for experiencing certain types of fractures. If you break a bone, you might need surgery to repair it.
Fractures are commonly caused by stress exceeding the rock strength, causing the rock to lose cohesion along its weakest plane. Fractures can provide permeability for fluid movement, such as water or hydrocarbons.What is fracture and dislocation? ›
A dislocation is where a bone has been displaced from its normal position at a joint. A fracture is when a bone has been broken.