Presentation
Forced handshake. Presents with pain and obvious deformity to right ring finger.
Patient Data
The lateral pre-reduction x-rays demonstrate a volar fracture-dislocation at the PIPJ of the right ring finger. There is a small dorsal fragment that appears to arise from the base of the middle phalanx.
The AP projection demonstrates the proximal phalanx projected over the middle phalanx with loss of the normal joint architecture.
Following reduction the joint is congruent on the lateral and AP radiographs. The small dorsal fragment arising from the base of the middle phalanx is evident with minimal displacement.
Case Discussion
Interphalangeal joint dislocations are common injuries in sport.
Volar dislocations at the PIP joint are less common than dorsal. Volar dislocations may be simple or rotatory. A rotatory-type dislocation involves injury to one of the collateral ligaments, which results in one of the proximal phalanx condyles passing between the central slip and lateral band.
Radiological evaluation post reduction of the central slip and collateral ligaments is required.
Boutonnière deformity may result from a volar dislocation secondary to rupture of the central slip. Appropriate evaluation for injury, splinting and follow up with a hand specialist is required.