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).

DIPJ dislocation

dorsalhandbonesAnatomy

The end joint of the finger is called the "distal interphalangeal joint" (abbreviated as "DIPJ"). It is the joint between the distal phalanx and the middle phalanx bones in the fingers.

Distal interphalangeal joint (DIPJ) dislocation commonly occurs from a sporting injury when there is a blow to the finger. The injury causes stretching or tearing of the ligaments, including the "volar plate" which is the ligament on the front of the joint.

Closed dislocation

hand with ring over bushA closed dislocation is when the joint is dislocated but there is no injury to the overlying skin - so the joint is not "open" to the external world. If a closed dislocation can be relocated it is not necessary to do surgery.

However, it can be difficult to achieve effective splinting of a DIPJ dislocation with a plastic splint, so in instances when this injury is associated with complete avulsion of the volar plate it may be preferable to repair the ligament surgically.

Open dislocation

dislocationDIPJfromRadiopaediaDOTorg

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 is recommended. 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

fingers walking up book staircaseThe 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.

FRACS

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