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1. International Journal of Orthopaedic Trauma 1994;4: 80
Complete volar dislocation of the
proximal interphalangeat joint of the
nftle finger
F O HASSAN
Summary
A complete volar dislocation of the proximal inter-
phalangeal (PIP) joint of a little finger occurred in a 52-
year-old man and was successfully treated by closed
reduction and a dynamic PIP extension splint.
Case report
A 52-year-old male stumbled while descending stairs and
fell down on his left hand.
Examination revealed flexion of the PlPjoint and extension
of the distal interphalangeal joint of the left little finger, with
no radial or ulnar deviation of the finger. There was no active
movement of the finger, nor neurovascular deficit; an X-ray
showed complete dislocation of the PIP joint (Figure 1).
Reduction was performed under entonox by traction and
extension. The collateral ligaments were stable after
reduction, but the joint was unstable in flexion of the finger.
A dynamic PIP extension splint with metacarpophalangeal
joint support was applied for six weeks, then a night splint
for four weeks. Regular follow-up for 14 months showed full
range of movement of the finger, no ligamentous laxity, nor
any residual deformity.
Discussion
Volar dislocation of the PlPjoint is a very rare injury compared
to the dorsal dislocation. Only L2 cases of this type have
been described in the literature,r-s and all were irreducible
due to soft tissue interposition or osteochondral fragment.
All of the reported cases necessitated open reduction.
The mechanism of the injury in our case was hyperflexion
force to the middle phalanx, although Spinner and Choi
found that a varus or valgus force was necessary to cause the
injury.s
Figure L Complete volar dislocation of the PIP joint of
the little finger.
There was no mention in the literature about the reducible
volar dislocation of the PIP, apart from the higher incidence
of the rupture of the extensor mechanism which needed to be
repaired, but this case showed that conservative treatment
may have a role.
References
1. Johnson FG, Greene MH. Another cause of irreducible
dislocation of the PIPJ of a finger. J Bone Joint Surg (Am)
1966; 482 542-4.
2. Inoue G, Maeda N. Irreducible palmar dislocation of the PIP
joint of the finger. Report 3 cases. J Hand Surg 1990; 15A:
301-4,
3. Murakami Y. Ireducible volar dislocation of the PIP joint of
the finger. Hand 1974; 6: 87-90.
4. Martin AP, Michael W. Irreducible volar dislocation of the
PIPJ of a finger caused by interposition of an intact central
slip. J Bone Joint Surg (Am) 1978; 60: 133-4.
5. Spinner M, Choi BY. Anterior dislocation of the PIPJ. J Bone
Joint Surg (Am) 1970; 52: 1329-36.
Department of Orthopaedic Surgery, University of Jordan, Amman, Jordan
Mr FO Hassan FRCS (Ene)
Correspondence to: Mr FO Hassan FRCS (Eng), Orthopaedic Registrar, Robert Jones
and Agnes Hunt Orthopaedic Hospital, Oswestry, Shropshire SYl0 7AG, UK.
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