Finger dislocation is a pathological condition in which the articular surfaces of the phalanges of the fingers are displaced and cease to be congruent to each other. Fingers suffer more often than toes. All phalanges can be dislocated: the main, middle and distal. Symptoms are sharp pain, swelling, deformity in the joint area and lack of movement. The diagnosis is established on the basis of external data and the results of radiography. Treatment is usually conservative – the reduction of the finger, followed by the application of a plaster cast. In some cases, fixation with a spoke or joint surgery is necessary.
ICD 10
S63.1 S93.1
Meaning
Finger dislocation is a steady displacement of the articular surfaces of the bones forming one of the joints of the finger. As a result of displacement, the articular surfaces lose congruence (cease to coincide with each other), movements in the joint become impossible. Dislocations of the fingers are observed quite often. Dislocations of the toes are rare. The treatment is carried out by orthopedic traumatologists.
Causes
The cause of damage to the finger of the hand is usually a household or sports injury: violent overextension or a blow to the finger area. Dislocation of the toe occurs due to a jump or fall. .
Classification
Depending on the level of damage, dislocations of the fingers are divided into dislocations of the main, middle and nail phalanges. When the main phalanx is dislocated, its articular surface shifts relative to the head of the corresponding metacarpal bone. With dislocation of the middle and nail phalanx, the articular surface of the distally located phalanx shifts relative to the proximal one. Depending on the direction of displacement, back, palmar and lateral dislocations are distinguished. Most often, there is a displacement of the bone to the back side. With dislocations of the toes, damage may occur in the area of the interphalangeal and metatarsophalangeal joint. The distal segment may shift to the plantar, dorsal or lateral side.
Types
Dislocation of the I finger of the hand
It can be back and palm, full and incomplete. Displacement to the rear is formed with the extensor mechanism of injury, displacement to the palm – with the flexor. With a dorsal dislocation, the tendon of the long flexor can shift and pinch between the articular surface of the proximal phalanx and the head of the metacarpal bone, making it difficult to set. At the moment of injury, there is a sharp pain. The finger is swollen, deformed in the area of the metacarpal joint. Active movements are impossible, when attempting passive movements, a spring resistance is determined.
With a back dislocation, the finger is shortened, bent in the metacarpal and unbent in the interphalangeal joint. The area of the tenar bulges out, the head of the I metacarpal bone is felt along the palmar surface, the articular surface of the main phalanx is felt along the back. With palmar dislocation, the finger is unbent in both joints and shifted to the palm side. The head of the I metacarpal bone is palpated on the back surface. To confirm the diagnosis, an X-ray of the I finger is performed. If a long flexor tendon is suspected of being pinched, an MRI or CT scan of the joint may be prescribed.
Treatment of a fresh dislocation of a finger is outpatient, carried out in a trauma center. The removal of finger dislocation is performed under local anesthesia. With a posterior dislocation, the traumatologist slightly withdraws the finger and pulls it along the axis, while simultaneously shifting the proximal phalanx to the head of the metacarpal bone. Traction can be carried out using a loop of bandage or using a conventional grip. In order to eliminate the infringement of the tendon, the finger is turned to the elbow side, while bending the nail phalanx. After reduction, immobilization is carried out with a spar for 3 weeks.
If the back dislocation cannot be corrected due to a pinched tendon, the patient is sent to the traumatology department for open reduction. The operation is performed under local or conductive anesthesia using a back-beam access. The pinched capsule is dissected, the tendon is shifted by the elevator to the side, after which the finger is easily adjusted. The wound is sutured in layers and drained with a rubber graduate. A longuette is applied for 3 weeks. The stitches are removed after 10 days.
Closed reduction of palmar dislocation is also carried out using traction along the axis. The finger is pulled out, unbent and pressed on the head of the metacarpal bone, shifting it to the palm side. The period of immobilization is 3 weeks. After reduction, with all dislocations of the finger, both palmar and back, UHF is prescribed. The ability to work is restored after 4-5 weeks.
Dislocations of the proximal phalanges of the II-V fingers
Usually there are back dislocations. The damage is accompanied by sharp pain, deformation, swelling of soft tissues. Movements in the metacarpal joint are impossible, spring resistance is determined. The head of the corresponding metacarpal bone is palpated on the palm, and the articular surface of the main phalanx is palpated on the back. The diagnosis is confirmed by finger x-ray. Outpatient treatment – closed reduction under local anesthesia followed by immobilization for 3 weeks. In this period, UHF and functional therapy are prescribed. The sick leave is closed after 4-5 weeks.
Dislocations of the nail and middle phalanges of the fingers of the hand
Usually they are rear, less often – side. The patient is worried about sharp pain. The finger is swollen, a bayonet-shaped deformation is detected in the area of the damaged joint. Movement is impossible. Sometimes dislocation is accompanied by the detachment of the extensor tendon, while the tendon usually breaks away from the attachment site along with a small bone fragment. To confirm the diagnosis, radiography of the fingers of the hand is prescribed, if a tendon separation is suspected, the patient may be referred for CT or MRI of the bone. Treatment of uncomplicated dislocations is outpatient. The finger is set under local anesthesia and a plaster is applied for 3 weeks. Treatment of complicated dislocations is carried out in a hospital. The damaged extensor tendon is sewn to the bone at the attachment site using transossal sutures. Finger dislocation is set, the wound is sutured. Immobilization is also carried out for 3 weeks.
The prognosis for dislocated fingers is favorable, in the absolute majority of cases, the volume of movements is fully restored, there are no pain in the long-term period. Habitual dislocations of the fingers occur extremely rarely. Untimely seeking medical help can lead to the development of an old dislocation. In such cases, simultaneous reduction is impossible, to restore the congruence of the articular surfaces, stabilization and development of the joint, it is necessary to apply the Volkov-Oganesyan apparatus. The outcome of an old dislocation may be arthrosis of the damaged joint.
Dislocations of the toes
Dislocation of the toes is a fairly rare injury. Dislocations of the distal phalanx of the I finger are more often observed, the second place is occupied by damage to the IV finger, the third finger suffers less often. Injury usually occurs as a result of indirect impact (impact on a solid object, falling from a height). There is a sharp pain, characteristic deformation, swelling, restriction of function, shortening of the finger and a symptom of springy immobility. The diagnosis is confirmed by the radiography of the toes. Treatment is usually outpatient – closed reduction of dislocation of the toe. If possible, manipulation should be carried out before the appearance of pronounced edema. Under local anesthesia, the traumatologist performs traction along the length, using a grip, gauze loop or a thin needle passed through the distal phalanx. At the same time, the doctor presses on the base of the displaced phalanx in the direction opposite to the displacement.
If the dislocation cannot be eliminated, they resort to open reduction in a hospital setting. In case of instability, transarticular fixation with a spoke is performed. With a single dislocation, a bandage consisting of several layers of adhesive plaster is sufficient for immobilization. In case of multiple injuries, it is necessary to apply a plaster cast. The patient is prescribed UHF. Fixation continues for 2-3 weeks, the ability to work is restored after 3-4 weeks. The prognosis is favorable, in most cases the movements are preserved in full, the support does not suffer, there are no pain in the long-term period.