Finger dislocations by jointMANAGEMENT

FOREARM, WRIST & HAND · 12 SECTIONS

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540 items

☷ Legend

01Approach to the Critical Patient/attcp70

Triage priorities

›Limb threat screen

›Neurovascular compromise

›Pallor

›Cool digit

›Capillary refill delay

›Absent Doppler signal

›Open joint or open fracture-dislocation

›Visible joint capsule

›Exposed tendon

›Compartment syndrome of hand

›Pain out of proportion

›Pain with passive stretch of digits

›Tense intrinsic compartments

›Irreducible dislocation

›Skin puckering at volar MCP

›Mechanical block to reduction

›Immediate actions

›Ring and constriction removal

›Cut ring if edema threatens perfusion

›Gross deformity reduction trigger

›Threatened skin or tenting

›Neurovascular deficit pre-reduction

›Analgesia plan before manipulation

›Digital nerve block pathway

›Procedural sedation pathway if needed

›Consultation and transfer triggers

›Hand surgery or orthopedics

›Open dislocation

›Complex MCP dislocation suspected

›Fracture-dislocation

›Persistent neurovascular deficit after reduction

›Suspected tendon rupture

›Volar PIP dislocation

›Rotatory PIP dislocation

›Emergent OR pathway

›Ischemic digit

›Open joint contamination

›Failed closed reduction with soft tissue interposition

Key concepts

›Injury map

›DIP dislocation

›Dorsal most common

›FDP avulsion association risk

›PIP dislocation

›Dorsal most common

›Volar plate injury common

›Central slip injury risk

›MCP dislocation

›Dorsal most common

›Volar plate interposition risk

›Thumb joints

›MCP dislocation

›CMC dislocation

›Imaging first vs reduce first

›Pre-reduction radiographs

›Stable neurovascular exam

›No threatened skin

›Immediate reduction before imaging

›Threatened skin

›Neurovascular compromise

›Severe deformity with pain crisis

›Post-reduction non-negotiables

›Neurovascular recheck documentation

›Pre-reduction status

›Post-reduction status

›Post-reduction radiographs

›Concentric reduction confirmation

›Occult fracture detection

›Early protected motion principle

›Stiffness risk with prolonged immobilization

›Stability-dependent splint plan

02History/hx35

Injury context

›Injury details

›Mechanism

›Hyperextension

›Axial load to fingertip

›Rotational force

›Sports ball impact

›FOOSH

›Time since injury

›Immediate vs delayed presentation

›Prior reduction attempt

›Hand dominance

›Dominant hand functional risk

›Occupation and sport

›Need for early function

›Symptoms and red flags

›Pain severity trajectory

›Escalating pain after splint

›Pain out of proportion

›Numbness and tingling

›Digital nerve distribution

›Weakness

›Inability to extend PIP

›Inability to flex DIP

›Skin break

›Wound contamination

›Bite mechanism

›Risk modifiers

›Anticoagulants or bleeding disorder

›Hematoma expansion risk

›Diabetes or peripheral vascular disease

›Ischemia risk

›Immunocompromise

›Infection risk with open injuries

›Prior hand surgery or hardware

›Altered anatomy risk

03Physical Exam/exam46

Hand and digit exam

›Inspection and alignment

›Deformity pattern by joint

›DIP dorsal prominence

›PIP dorsal step-off

›MCP dorsal prominence

›Skin integrity

›Open wound over joint

›Skin tenting and blanching

›Volar skin puckering at MCP

›Swelling and ecchymosis

›Collateral ligament injury clue

›Neurovascular status

›Perfusion

›Capillary refill

›Temperature compared to adjacent digits

›Pulses

›Radial pulse

›Ulnar pulse

›Doppler digital artery if concern

›Sensation

›Two-point discrimination if feasible

›Radial and ulnar digital nerve territories

›Motor

›FDP function

›DIP flexion isolated

›FDS function

›PIP flexion isolated

›Extensor mechanism

›Active PIP extension

›Active DIP extension

›Joint stability and soft tissue injury screen

›Collateral ligament integrity

›Varus and valgus stress at 30 degrees flexion after reduction

›Volar plate injury

›Hyperextension laxity after reduction

›Central slip injury suspicion

›Weak PIP extension against resistance

›Boutonniere risk counseling trigger

›PITFALLS

›Missed fracture-dislocation

›Volar lip fracture of middle phalanx

›Dorsal subluxation on lateral view

›Missed tendon injury

›FDP avulsion masquerading as simple DIP injury

›Persistent rotational deformity

›Malrotation on finger flexion cascade

04Differential Diagnosis/ddx30

Traumatic and atraumatic mimics

›Traumatic differentials

›Phalanx fracture

›Proximal phalanx fracture

›Middle phalanx fracture

›Distal phalanx fracture

›Intra-articular fracture

›PIP volar lip fracture

›MCP metacarpal head fracture

›Tendon rupture

›Mallet finger

›ICD-10 M20.0

›Jersey finger

›FDP avulsion

›Ligament injury without dislocation

›Collateral ligament tear

›Volar plate tear

›Infection and inflammatory mimics

›Septic arthritis

›Hot swollen joint without clear trauma

›Crystal arthritis

›Acute monoarthritis at MCP or PIP

›Coding alignment

›Finger joint dislocation

›ICD-10 S63.2

›Thumb dislocation

›ICD-10 S63.1

›SNOMED CT concepts for dislocation documentation

›Dislocation of finger joint

›Dislocation of interphalangeal joint of finger

›Dislocation of metacarpophalangeal joint of finger

05Laboratory Tests/lt18

When labs matter

›Minimal labs for isolated closed dislocation

›No routine labs for uncomplicated cases

›Point-of-care glucose only if sedation risk or diabetes concern

›Open injury or bite mechanism

›Infection risk labs

›CBC for systemic infection concern

›CRP for complicated infection concern

›Renal function for antibiotic selection

›Creatinine and eGFR

›Procedural sedation pathway

›Targeted testing only

›Pregnancy test when applicable

›Glucose for altered mental status concern

›Hemoglobin for significant bleeding concern

›Compartment syndrome or crush injury concern

›Rhabdomyolysis screen

›CK

›Creatinine and potassium

06Diagnostic Tests/dt38

Scoring Systems

›Injury classification and stability cues

›PIP fracture-dislocation stability concept

›Volar lip fracture size association with instability

›Persistent dorsal subluxation on lateral view

›MCP dislocation type

›Simple dislocation

›Complex dislocation with volar plate interposition

Radiographs

›Plain radiography strategy

›Views

›AP

›True lateral

›Oblique

›Timing

›Pre-reduction films when stable

›Post-reduction films always

›Key radiographic findings

›Concentric reduction

›Avulsion fracture fragments

›Volar plate interposition signs

›Dorsal subluxation at PIP after reduction

›Thumb specific imaging

›Thumb CMC views if suspected

›Stress views avoided acutely if unstable pain

MRI

›Soft tissue characterization

›Indications

›Suspected central slip rupture with equivocal exam

›Suspected volar plate rupture with persistent instability

›Persistent pain despite normal radiographs

›Limitations

›Not first-line in ED for simple dislocation

›Management usually guided by exam and radiographs

›Complex bony injury definition

›Indications

›Intra-articular fracture-dislocation with surgical planning need

›Occult fracture suspected with high-risk exam

›Utility

›Articular step-off definition

›Fragment size and impaction assessment

07Disposition/dispo28

Site of care and follow-up

›Discharge criteria

›Concentric reduction confirmed

›Post-reduction radiographs acceptable

›Stable neurovascular exam

›Normal perfusion

›Normal or baseline sensation

›Pain controlled with oral regimen

›Tolerable pain at rest

›Reliable follow-up plan

›Hand surgery or orthopedics referral timeframe

›Admission or transfer criteria

›Open dislocation

›Antibiotics and operative irrigation pathway

›Irreducible dislocation

›Suspected soft tissue interposition

›Fracture-dislocation unstable

›Persistent subluxation after reduction

›Neurovascular compromise

›Persistent deficit post-reduction

›Follow-up timing

›Simple stable PIP or DIP dislocation

›Hand clinic within 3 to 7 days

›Unstable PIP dislocation

›Hand surgery within 24 to 72 hours

›MCP dislocation

›Hand surgery within 3 to 7 days

›Thumb CMC dislocation

›Hand surgery within 24 to 72 hours

08Treatment/t148

Immediate life-saving interventions

›Limb threat actions

›Ischemic digit pathway

›Immediate reduction attempt if deformity likely cause

›Hand surgery escalation if no rapid reperfusion

›Constriction relief

›Ring cutting

›Splint loosening if worsening perfusion

›Open injury actions

›Cover with sterile saline dressing

›Avoid probing in ED

›Antibiotics and tetanus pathway before definitive management

›Timing within 1 hour when feasible

Immobilization and Splinting

›Immobilization choices

›DIP dislocation post-reduction

›Finger splint in extension

›Buddy tape if stable and pain allows

›PIP dorsal dislocation post-reduction

›Extension-block splint

›PIP flexion 20 to 30 degrees for 2 to 3 weeks

›Buddy taping to adjacent finger

›Early protected motion within 1 week as tolerated

›PIP volar dislocation post-reduction

›Extension splint

›PIP in full extension

›Longer immobilization if central slip injury suspected

›MCP dislocation post-reduction

›Dorsal blocking splint

›MCP flexion 70 to 90 degrees

›IP joints free for motion

›Thumb CMC or thumb MCP dislocation post-reduction

›Thumb spica splint

›Wrist neutral

›Thumb in functional abduction

›Splint safety checks

›Post-splint neurovascular exam

›Capillary refill

›Sensation

›Active motion of non-immobilized joints

›Swelling precautions

›No circumferential cast in acute edema phase

›Elevation instructions

Reduction

›Reduction indications

›Neurovascular compromise

›Threatened skin

›Significant deformity and pain

›Fracture-dislocation with gross malalignment

›Contraindications and caution triggers

›Open dislocation

›Antibiotics and tetanus first when feasible

›Urgent hand surgery consultation

›Suspected complex MCP dislocation

›Volar skin puckering

›Mechanical block

›Pediatric physeal injury suspicion

›Gentle technique

›Low threshold for specialist involvement

›Analgesia and anesthesia

›Digital nerve block

›Lidocaine 1% without epinephrine

›Volume 1 to 3 mL per side of digit

›Maximum dose 5 mg/kg

›Lidocaine 1% with epinephrine 1:100,000 to 1:200,000 option in healthy digits

›Longer duration anesthesia

›Avoid in severe peripheral vascular disease

›Bupivacaine 0.25% option

›Longer duration anesthesia

›Maximum dose 2.5 mg/kg

›Adjunct analgesia

›Acetaminophen PO

›15 mg/kg per dose

›Maximum 1,000 mg per dose

›Ibuprofen PO

›10 mg/kg per dose

›Maximum 600 mg per dose

›Procedural sedation triggers

›Multiple digit involvement

›Severe anxiety

›Failed block or intolerance

›Reduction technique principles

›Traction and countertraction

›Gentle sustained traction

›Avoid repeated forceful attempts

›Reverse mechanism

›Dorsal dislocation

›Distal segment hyperextension then flexion

›Volar dislocation

›Distal segment flexion then extension

›Joint-specific maneuvers

›PIP dorsal dislocation

›Slight hyperextension to disengage

›Volar pressure on base of middle phalanx

›Controlled flexion into reduction

›PIP volar dislocation

›Gentle traction

›Dorsal pressure on base of middle phalanx

›Controlled extension into reduction

›DIP dorsal dislocation

›Longitudinal traction

›Volar pressure on distal phalanx base

›Return to extension

›MCP dorsal dislocation

›Hyperextension of proximal phalanx then reduction over metacarpal head

›Avoid excessive in-line traction that may worsen interposition risk

›Post-reduction requirements

›Neurovascular exam repeat

›Sensation documentation

›Capillary refill documentation

›Radiographs post-reduction

›Concentric reduction confirmation

›Avulsion fracture assessment

›Stability assessment after reduction

›Active ROM tolerance

›Collateral ligament stress testing when appropriate

›Failed reduction pathway

›Immediate escalation criteria

›Persistent ischemia

›Increasing pain with passive stretch

›Hand surgery consultation triggers

›Suspected complex MCP dislocation

›Volar plate or tendon interposition suspected

›Recurrent dislocation after reduction

Open fracture medications and timing

›Open dislocation and open fracture-dislocation pathway

›Antibiotics

›Cefazolin IV 2 g

›Pediatrics 50 mg/kg IV

›Maximum 2 g per dose

›Severe penicillin allergy alternative

›Clindamycin IV 600 to 900 mg

›Pediatrics 10 mg/kg IV

›Gross contamination concern

›Add gentamicin per local protocol

›Tetanus prophylaxis

›Tdap if immunization unknown or not up to date

›Tetanus immune globulin if high-risk wound and incomplete immunization

›Wound care

›Irrigation in ED for gross contamination only

›Sterile dressing and splint

›Bite mechanism

›Amoxicillin-clavulanate PO

›875/125 mg PO twice daily

›Pediatrics 25 to 45 mg/kg/day divided twice daily

›Hand surgery consultation low threshold

DVT prophylaxis when relevant

›Not routinely indicated for isolated finger immobilization

›Consider only if additional major risk factors

›Active malignancy

›Recent major surgery

›Prior VTE

›Prolonged lower limb immobilization concurrent

09Special Populations/sp32

Pregnancy

›Pregnancy considerations

›Imaging safety

›Hand radiographs acceptable with shielding

›Avoid unnecessary CT

›Analgesia selection

›Acetaminophen preferred

›NSAID avoidance in later gestation per obstetric guidance

›Procedural sedation

›Obstetric consultation if advanced gestation and deep sedation anticipated

Geriatric

›Older adult considerations

›Osteoporosis and fragility mechanism

›Low-energy falls with occult fracture risk

›Skin integrity risk

›Lower threshold for reduction of tenting

›Medication sensitivity

›Lower opioid dosing

›Delirium risk with sedatives

›Follow-up needs

›Earlier reassessment for swelling and splint tolerance

Pediatrics

›Pediatric considerations

›Physeal injury risk

›Salter-Harris patterns near PIP and MCP

›Gentle reduction technique

›Nonaccidental trauma screen when inconsistent story

›Age-inappropriate mechanism

›Multiple injuries

›Weight-based dosing

›Local anesthetic maximum dose calculation

›NSAID dosing per kg

›Immobilization tolerance

›Cast or splint integrity monitoring

›Caregiver education emphasis

10Background/b47

Epidemiology

›Epidemiology summary

›PIP dislocation

›Most common finger dislocation type

›MCP dislocation

›Rare incidence

›Less than 1 per 100,000 annually reported for MCP dislocations

›Sports association

›Ball sports and falls common mechanisms

›Anatomic distribution notes

›Non-thumb MCP dislocation

›Index finger most commonly involved

Pathophysiology

›Mechanism to injury mapping

›Dorsal PIP dislocation

›Hyperextension force

›Volar plate disruption

›Possible volar lip avulsion fracture

›Volar PIP dislocation

›Axial load with flexion

›Central slip disruption risk

›Dorsal MCP dislocation

›Hyperextension with metacarpal head buttonholing risk

›Volar plate interposition mechanism for complex dislocation

›DIP dislocation

›Axial load to distal phalanx

›FDP avulsion association risk

Therapeutic Considerations

›Reduction rationale

›Skin and soft tissue protection

›Reduce tenting and ischemia risk

›Joint congruity restoration

›Cartilage injury mitigation

›Early motion importance

›Stiffness prevention

›Function restoration

›Splinting rationale

›Dorsal PIP dislocation

›Extension-block splint to protect volar plate

›Volar PIP dislocation

›Extension splint to protect dorsal structures

›MCP dislocation

›Flexion splint to relax volar plate and collateral ligaments

›Evidence framing

›Extension-block splinting at 20 to 30 degrees flexion for dorsal PIP dislocation supported in primary care guidance

›Protected early motion within 1 week encouraged as tolerated

›Lidocaine with epinephrine in digital blocks reported safe in healthy patients

›Concentrations 1:100,000 to 1:200,000 commonly cited

›Complex MCP dislocation typically requires operative management when closed reduction fails

›Volar plate interposition common block

11Patient Discharge Instructions/pdi27

copy discharge instructions

›Discharge instructions

›Splint care

›Keep splint clean and dry

›Elevation above heart for first 48 to 72 hours

›Ice over splint 10 to 15 minutes at a time

›Activity restrictions

›No sports until cleared

›No lifting or gripping with injured hand until follow-up

›Pain plan

›Acetaminophen as directed

›Ibuprofen as directed if safe

›Finger motion plan

›Move non-splinted joints several times daily

›Buddy tape care if provided

›Return to ED immediately for

›Increasing pain not controlled by medication

›New numbness or worsening tingling

›Pale or blue fingertip

›Cold fingertip

›Swelling causing tight splint pressure

›Inability to move fingertip after reduction

›Wet or broken splint

›Fever

›Redness, pus, or worsening wound drainage

›Follow-up

›Hand clinic or orthopedics within recommended timeframe

›Earlier follow-up if splint discomfort or swelling progression

12References/r21

Clinical guidelines and evidence-based sources

›References

›AAFP Common Finger Fractures and Dislocations

›Dorsal PIP extension-block splint 20 to 30 degrees for 2 to 3 weeks

›Early protected motion within 1 week as tolerated

›StatPearls Finger Dislocation

›MCP dislocation reduction principles

›Volar plate interposition risk in complex dislocations

›Orthobullets MCP Dislocations

›MCP incidence rare

›Open reduction indication when soft tissue interposition blocks reduction

›Orthobullets Phalanx Dislocations

›Extension-block splinting for unstable dorsal PIP

›Extension splinting duration considerations for volar PIP

›AAFP Proper Technique for Reduction of MCP Dislocations

›Hyperextension maneuver and reduction mechanics

›Systematic review Safety of epinephrine in digital nerve blocks

›Epinephrine 1:100,000 to 1:200,000 safety in healthy digits

›Cochrane review Adrenaline with lidocaine for digital nerve blocks

›Evidence synthesis on safety and effects

›Digital nerve blocks systematic review and meta-analysis

›Technique comparisons for onset and duration

Evidence & Review

Reviewed by SymptomDx Medical Team · Last reviewed March 6, 2026

SymptomDx is an educational tool for medical professionals. It does not replace clinical judgment. Verify all clinical data and drug dosages with authoritative sources.