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DIPJ and MCPJ with full motion, PIPJ splinted in full extension
51%
440/859
DIPJ and MCPJ with full motion, PIPJ with extension block splinting
16%
141/859
DIPJ and PIPJ with extension block splinting, MCPJ with full motion
8%
72/859
DIPJ and PIPJ splinted in full extension, MCPJ with full motion
DIPJ, PIPJ, and MCPJ with extension block splinting
7%
59/859
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This patient has a volar PIPJ dislocation. Concentric reduction of the joint without fracture is best treated with the PIPJ in full extension to allow healing of the central slip while allowing motion at the MCPJ and DIPJ. Phalanx dislocations are common traumatic injuries of the hand involving the PIPJ or DIPJ. Diagnosis can be made clinically and is confirmed with orthogonal radiographs. Treatment is closed reduction and splinting unless volar plate entrapment blocks reduction or a concomitant fracture renders the joint unstable. Volar PIPJ dislocations are much less common than dorsal dislocations. Concentric reduction of the joint without fracture is best treated with the PIPJ in full extension to allow healing of the central slip while allowing motion at the MCPJ and DIPJ to permit motion of the lateral bands. Elfar et al. reviewed fracture-dislocations of the PIPJ. They reported on the three fracture-dislocation patterns are recognized: dorsal, volar, and pilon. They noted that an acceptable outcome is dependent on achieving and maintaining a well-aligned and well-reduced joint, re-establishing normal joint kinematics, and restoring motion. They concluded that the optimal outcome for a specific injury is predicated on expedient diagnosis and recognition of injury severity, which enables the initiation of appropriate management. Saitta et al. reviewed PIPJ dislocations. They reported that a concentric stable reduction can commonly be achieved with closed reduction. They concluded that occasionally, PIPJ dislocations are irreducible and open reduction is necessary. Miller et al. reviewed finger joint dislocations. They reported that simple dislocations are frequently amenable to early return to play with protection; however, more complex injuries may require specialized splinting or surgery. They concluded that early diagnosis and appropriate treatment are essential to ensure optimal functional results. Incorrect Answers: Answers 2,3,&5: Extension block splinting and range of motion in the stable range of joint flexion is appropriate for dorsal dislocations. Answer 4: The PIPJ should be splinted in full extension and the DIPJ and MCPJ should not be immobilized to effectively permit motion of the lateral bands while avoiding the consequences of mismanaging the central slip of the extensor mechanism.
3.0
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