Hand Case 16 ED Management

Reduction: 

1. Disengage by pulling in the direction of the dislocation to disengage form the articular plate. In this case pull dorsally (purple arrow)

2. Firmly and smoothly apply longitudinal traction (red arrow)

3. Flex into place (green arrow)

These steps should all be done in one smooth, swift and rapid motion.

This can be done without anesthesia in cooperative patients since these tend to reduce rapidly. Digital block anesthesia can be offered to apprehensive patients. 

 

 

Post Reduction: 

1. Assess joint stability by ranging the PIP medially and laterally to detect any laxity

          - If stable dorsal or lateral dislocation, buddy tape to the adjacent finger for 3-6 weeks 

          - If volar dislocation or unstable joint, immobilize the joint in 20-30 degrees flexion for 3 weeks

          - If there is evidence of complete ligamentous disruption in all directions on post-reduction range of motion testing immobilize and refer to a hand surgeon for possible operative repair. 

    2. Obtain post-reduction x-rays

 

 

          - If there is associated volar (arrow above) or dorsal plate fractures, refer to our associated cases for management: Hand Case 12

          - If the joint is irreducible, the articular cartilage may be entrapped. A hand specialist should be immediately consulted.