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).

PIPJ dislocation

outstretched index fingerAnatomy

The end joint of the finger is called the "distal interphalangeal joint" (abbreviated as "DIPJ"). The finger joint that is closer to the knuckle is called the "proximal interphalangeal joint" (abbreviated as "PIPJ").

Proximal interphalangeal joint (PIPJ) dislocation

Dislocated finger x-rayThe most common ways to dislocate the PIPJ are in a sporting injury or fall. In most instances it is possible to relocate the joint without surgery. In hospital an X-ray is performed before and after the relocation, so that any fracture can be detected. After the finger is relocated it is common to see a tiny fracture (or small fuzzy area) at the front of the finger, which usually is a sign of a volar plate injury (also termed a "volar plate avulsion"). The volar plate is a ligament on the front of the finger that stops your fingers from bending over backwards.Finger dislocation

A volar plate avulsion can be repaired surgically, but more commonly the ligament injury is managed with splinting and mobilisation. The splint prevents the finger from straightening fully, allowing the ligament to heal and for stability to be regained. Note that the finger is not splinted straight for weeks on end. It is equally important to flex the joint regularly, so that the range of movement is maintained. In the first few days the finger will usually be too sore and swollen to move much.Finger luxation002

Sometimes a severe PIPJ dislocation will completely disrupt both the volar plate and the collateral ligaments. In this instance the joint will not look completely back in position on the second X-ray; this type of injury usually requires surgery.

Open dislocation

PIPJdislocationfromradiopaediaDOTorg

An "open" dislocation occurs when the force of the dislocation tears the tissues overlying the joint, resulting in a wound that allows the joint to communicate with the outside world. This carries a significant risk of infection. Antibiotics and surgical washout of the joint are necessary. At the time of the washout the surgeon will commonly repair any injured ligaments. You will be placed in a splint and commence movement exercises around a week after surgery.

Overall goal

happy man on phone striped shirtThe most important goals in treating a dislocated finger are to end up with a mobile, stable finger. You want your finger to have a full range of movement and to not be unstable in any particular direction. Achieving this requires a careful balance of stillness (splinting) and movement (finger exercises), and sometimes (but not usually) surgery. Please call Melbourne Hand Surgery if you have any concerns!

FRACS

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