Houston Methodist. Leading Medicine

Hand FAQ

Question:

Our son got his middle finger jammed during a wrestling match. The middle joint of the middle finger is dislocated. They are talking about doing surgery. How can we tell if this is really the right treatment? Can't they just pull it back in place and put a splint on the finger? Why would surgery be needed?

Answer:

Dislocations of the proximal interphalangeal (PIP) joint (middle joint of the finger) can be complex and challenging. Treatment is not always straightforward, especially when there is a fracture involved. Decisions are made based on the extent of damage, percentage of joint surface that is involved if there was a fracture, and presence of joint instability. The surgeon must rely on clinical judgment evaluating each and every patient individually. Damage to the cup-shaped joint along with injury to the ligaments can result in an unstable joint. The most successful treatment of these injuries involves limited immobilization with a finger splint and early motion of the finger. Keeping the gliding and sliding motion of the joint is very important -- even more so than fixing the dislocation. Every effort is made to prevent complications such as chronic swelling, stiffness, deformity, and loss of finger function. When the volar plate (restraining ligament) of the joint is damaged by the dislocation, redislocation can occur. Conservative (nonoperative) care is advised when the dislocation is considered "stable". Stability is determined by X-rays based on how much of the joint surface is damaged (fractured). The surgeon also looks at whether or not the joint partially or completely dislocates during motion. The use of splinting during the early (acute) phase of healing is possible. A balance is essential between maintaining the joint in a stable position while still allowing motion. But any sign of redislocation while the finger is in the splint (or after splinting comes to an end) is an indication that surgery is needed. Surgery is suggested when the joint is unstable, chronically dislocating, and/or if conservative care does not correct the contracture or deformity. The type of surgery performed is surgeon-determined and may include reconstruction of the cup-shaped contour of the joint, pinning the joint to block full extension (and thereby protect healing soft tissue structures), and/or fixation (internal or external) of the volar plate with mini-screws, pins, or wires. There are advantages and disadvantages to each surgical procedure. The surgeon who is recommending surgery will likely be willing to explain why surgery is being considered. Any questions you may have should be voiced before the final decision is made. This will help you understand the surgeon's decision-making process as well as offer insights and information about your son that might be important. John J. Mangelson, MD, et al. Complications Following Dislocations of the Proximal Interphalangeal Joint. In The Journal of Bone & Joint Surgery. July 17, 2013. Vol. 95A. No. 14. Pp. 1326-1332.

*Disclaimer:* The information contained herein is compiled from a variety of sources. It may not be complete or timely. It does not cover all diseases, physical conditions, ailments or treatments. The information should NOT be used in place of visit with your healthcare provider, nor should you disregard the advice of your health care provider because of any information you read in this topic.
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