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Hand Case 7 ED Management

Volar PIP dislocation with ring on finger (with fracture fragment)

ED Management

Ring removal is the first priority for any injury with potential for digit swelling. If not removed, the finger will continue to swell until there is vascular compromise. Removal becomes more difficult as the finger swells more with time, so removal should usually proceed prior to plain films. The finger may require digital block anesthesia. If application of a lubricant does not lead to successful removal, "string wrap" technique or a ring cutter are other options.

Reduction involves mild exaggeration in the direction of the dislocation to disengage from the articular plate. Then the clinician applies longitudinal traction and firm pressure on the proximal aspect of the middle phalanx to reduce the fracture. Immobilize the joint in 20-30 degrees flexion for three weeks.

If the joint is irreducible, the articular cartilage may be entrapped, and a hand specialist should be immediately consulted. If there is evidence of complete ligamentous disruption in all directions on postreduction range of motion testing, refer to a hand surgeon for possible operative repair. Volar dislocations are more difficult and often result in hand consultation.