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BUTTONHOLE

DISLOCATION

Hanif Andhika W
MCP DISLOCATIONS

Epidemiology:

dorsal dislocations most common

index finger most commonly involved


MECHANISM:

hyperextension injury
REDUCTION OF FINGER
DISLOCATION TECHNIQUE

Time is of the essence in dislocations. Delay


swelling and muscle spasm
Adequate anesthesia is key to a successful
reduction
joint stability must be checked and postreduction
films obtained.
The most common causes of inability to reduce a
dislocation:
Avulsion fracture involving the joint, a trapped
tendon, a buttonhole tear through the volar plate,
and significant swelling
REDUCTION OF DISLOCATION IN DIGITS 2-
5

Distal interphalangeal joint


To reduce a dislocated distal interphalangeal
(DIP) joint, apply gentle longitudinal traction
with hyperextension or hyperflexion, followed by
pressure to the base of the distal phalanx in the
direction that realigns the phalanges.
Splint a volar dislocation without a tendon injury
by applying a dorsal splint in mild flexion. To
splint a dorsal dislocation without a tendon
injury, use a dorsal splint in extension
PROXIMAL INTERPHALANGEAL JOINT

Dorsal dislocations
Apply longitudinal traction with hyperextension,
followed by pressure to the dorsal aspect of the
base of the middle phalanx as the finger is
brought into flexion. Apply a dorsal splint with
20-30 of flexion.
If an associated fracture of the volar lip affects
more than 33% of the joint surface, a closed
reduction will be unstable and operative repair is
necessary because the collateral ligament is
attached to the bony fragment.
LATERAL DISLOCATIONS
Apply longitudinal traction and ulnar or radial
stress to the finger, depending on the initial
direction of injury. Partial tears can be buddy-
taped; reduced dislocations (ie, complete tears)
should be splinted.
VOLAR DISLOCATIONS
Apply mild traction with the PIP and
metacarpophalangeal (MCP) joints flexed. Splint
only the PIP joint in full extension. Some argue
that all volar PIP joint dislocations should be
reduced in the operating room, on the grounds
that entrapment of the lateral band around the
head of the proximal phalanx may block
reduction
METACARPOPHALANGEAL JOINT

Simple dorsal dislocations (subluxations)


This injury can be reduced nonoperatively. Flex
the wrist (thereby relaxing the flexor tendons).
Hyperextend the affected digit and place
pressure over the dorsum of the proximal
phalanx in a distal and volar direction. Avoid
excessive hyperextension or longitudinal traction,
which can convert a simple dislocation to a
complex dislocation. Splint in flexion; some argue
that buddy-taping is sufficient
COMPLEX (COMPLETE) DORSAL
DISLOCATIONS

This injury must be reduced operatively because


the volar plate has been displaced into the MCP
joint. Volar, lateral, and complex dorsal MCP
joint dislocations of the finger must be evaluated
and treated by a hand surgeon. A mild
compression dressing with gentle plaster
reinforcement is placed temporarily until the
patient can be evaluated by a hand surgeon.