Volar Dislocations of the Proximal Interphalangeal Joint

Lisa L. Lattanza and Steven Z. Glickel

History and Clinical Presentation

A 20-year-old woman sustained an injury to her right ring finger during a tackle while playing rugby. She was not able to describe the exact mechanism, as it happened in a “pile-up.” She was seen in the emergency department that day.

Physical Examination

A swollen and tender proximal interphalangeal (PIP) joint of the right ring finger was noted, with slight rotational deformity of the digit. The patient was unable to actively extend the PIP joint. There was brisk capillary refill of the digit and the skin was intact.

Diagnostic Studies

PIP joint sprain

Dorsal PIP joint dislocation

Volar PIP joint dislocation

Middle phalanx fracture

Proximal phalanx fracture

PIP joint fracture/dislocation

Diagnosis

Volar PIP Dislocation

Unlike dorsal PIP joint dislocations, volar dislocations are rare. It is important to understand the mechanism of injury and the resultant damage to the underlying structures to devise a sensible treatment plan. It is also necessary to differentiate the straight volar dislocation from the volar rotatory dislocation as the structures damaged, and therefore the treatment, are different.

Nonsurgical Management

There are two types of volar PIP joint dislocations: a straight volar dislocation and the volar rotatory dislocation. To fully understand the management of these two distinct entities, it is essential to understand the different injuries.