Melbourne Hand Surgery 

Coronavirus update: We will be closed on Wednesday 8 April, but will reopen at 8:30am on Thursday 9 April. 

Melbourne Hand Surgery has mechanisms to protect our patients and staff while we continue to provide healthcare services. All consultations are now conducted via telehealth (phone or videoconference), except where we have previously confirmed the requirement for an in-person physical examination or wound care management.  Only emergency surgery is being conducted in hospitals for the foreseeable future, in keeping with Government directives. 

Due to the change in circumstances we will be closed on Fridays until further notice. If our practice is unable to physically open for business at any point in the coming weeks or months we will communicate this to existing scheduled patients via email and SMS (please do not attempt to reply other than with Y or N to an SMS, as the automated system does not facilitate this). Incoming telephone calls and receipt of voicemail messages may be temporarily affected by such a change. We will use this website banner to update you on changes to our practice and the availability of non-urgent procedures and surgery in the weeks and months ahead. Thank you for your understanding as our entire community works through these unprecedented and rapidly evolving times together (last updated: 4 April 2020).

Hand and Wrist Dislocations

Finger luxation002What is a dislocation?

A dislocation is an injury where the two bones that meet at a joint become separated, so that they no longer sit together. In many instances the injury occurs during sport and it is not uncommon for the dislocation to be reduced (relocated) by an athlete, trainer or coach.

How are dislocations assessed?

Finger joints are commonly reduced in a hospital emergency department with local anaesthetic used to numb the finger. Occasionally the joint can't be reduced in the emergency department and an operation is required. It is good practice to have an X-ray before and after a joint is relocated, so that any fracture can be identified.

dislocatedthumbfromtomsteinfortAfter the joint is relocated it is important to check the stability of the collateral ligaments, to see if the finger bends to the side in an abnormal manner. If the collateral ligaments have also been injured this will need to be taken into consideration when planning treatment and rehabilitation.

Sometimes when a joint dislocates the skin overlying it tears open. If this occurs it is necessary to have antibiotic treatment and an operation to wash out the joint, because bacteria from the skin or environment can infect the joint and cause major problems.

My x-ray shows a fracture

Minor fractures often occur with finger dislocations. These small fractures (termed "avulsion fractures") can occur if a stretched ligament pulls off a fragment of bone where it inserts (this is especially common with a volar plate injury). Most of these minor fractures do not require surgery.

Sometimes hand injuries that cause a dislocation will also create a more significant fracture at the same location. These injuries commonly require surgery to maintain the bones in the proper position while they heal and to restore hand function.

Finger luxation003How are dislocations treated?

Treatment for dislocations often includes treatment of swelling, specific exercises, splinting and buddy-strapping.

What are the possible complications?

The main complications from joint dislocation are instability (where the joint is too mobile), stiffness (where the joint is not mobile enough) and rarely post traumatic arthritis. Patients are often surprised that their joint is still swollen 2-3 weeks later, but this is actually not surprising because it is a significant injury that usually involves significant bleeding into the joint and bruising of ligaments and soft tissues. Hand therapy plays a crucial role in reducing swelling and achieving a normal range of joint movement.

 Photo Credit: Twitter Account @tomsteinfort

FRACS

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