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Multiple dislocations of a single finger
Multiple Dislocations o~ a Single Finger--Fred F. Nathan and Allen P. Schlein
M U L T I P L E DISLOCATIONS OF A SINGLE F I N G E R
F R E D F. N A T H A N and A L L E N P, SCHLE1N, Chicago The treatment of dislocations of the proximal and distal interphalangeal joints of the finger are commonplace to any orthopaedic surgeon in practice. However, more than one dislocation occurring in a single finger seems to be an unusual occurrence. This fact was pointed out when we recently reviewed the literature after having been confronted with a double dislocation and, therefore, prompted us to report the case. CASE REPORT
A 44 year old policeman in the Chicago Police Force was playing baseball and sustained a dorsally directed injury to the tip of the right little finger. He had an obvious deformity of the little finger, with dorsal prominence of the middle and distal phalanges, and a double stepladder defect. The nerves and vessels were undamaged. The patient was reluctant to have the finger touched because of the pam. X-rays revealed a dorsal subluxation of the distal phalanx on the head of the middle phalanx; the middle phalanx was subluxated dorsally on the head of the proximal phalanx. Both dislocations were reduced with a 1% xylocaine block of the common digital nerve in the palm, and the finger was splinted on a malleable aluminium splint padded with foam. When seen two days later there was no gross deformity, although there was moderate swelling in and about the proximal and distal interphalangeal joints of the right little finger. The longitudinal splint was removed and a wrist gauntlet plaster cast, extending to the ring and little fingers, applied. The cast was left in place for two and a half weeks. The patient was then instructed to mobilise the hand. The joints were comfortable and minimally swollen.
Fig. 1 Patient on presentation to the emergency room with the double dislocation of the
little finger, with dorsal subluxation and ulnar deviation of the proximal joint.
52
The H a n d - - V o l . 5
No. 1
1973
Multiple Dislocations o] a Single Finger--Fred F. Nathan and Allen P. Schlein
Fig. 2 Initial splint applied after reduction of double dislocation. The patient was finally examined one month subsequent to injury, at which time he had 40 degrees of active flexion of the distal joint, and 60 degrees of active flexion of the middle joint. The hand was comfortable and function was good. X-rays showed good alignment and satisfactory position of the finger. DISCUSSION
A review of the literature revealed few descriptions of interphalangeal dislocations occurring simultaneously in one finger. The first description was in 1874 by Bartels who described a twenty-five year old female with a double dislocation. There was a single report in the English literature by Sayre in 1892 of a fiftythree year old carpenter who sustained a double dislocation. Subsequently there were two reports in German, one in 1931 by Scholle, describing a double dislocation of the ring finger of a fifty year old male, and one in 1932 by Sch~Srcher who described a double dislocation of a finger in a forty-three year old male. In 1957, Berenyi reviewed the literature and reported a single case of his own in the Hungarian literature. However, there does not appear to be a similar review published in the English literature. This would, indeed, appear to be a rare phenomenon. The treatment of a double dislocation is obviously no problem whatsoever. All cases reported have been easily reducible and, with splinting to allow soft tissue healing, seemed to do well. Some of the cases have been reduced under a local anaesthetic, some with no anaesthetic, and some with systemic analgesia. The mechanism of dislocation is agreed upon by the authors reporting. They all feel that the position of the hand at the time of the accident, along with the direction of force from volar to dorsalward determine the hyperextension initially of the distal joint. The forces are then not sufficiently dissipated, and a subsequent tear of the volar capsule of the proximal joint occurs, with hyperextension, causing the base of the middle phalanx to dislocate on the dorsum of the head of the proximal phalanx. By nature of the anatomical structure of the distal and middle joints, the greatest weakness appears to be on the dorsum. In addition, the contour The H a n d - - V o l . 5
No. 1
1973
53
Multiple Dislocations o/ a Single Finger--Fred F. Nathan and Allen P. Schlein
of the joint surfaces of the proximal and middle phalangeal heads appears to direct the dislocation dorsally SUMMARY
This report describes the case of a forty-four year old male with a double dislocation of the little finger. The treatment of this double dislocation presents no problem; however its rarity makes it worthwhile to be reported in the English literature. The mechanism and treatment are briefly discussed.
REFERENCES
BARTELS, M. (1874) Traumatische Luxationen. Archiv ft~r Klinische Chirurgie 16: 636-654. SAYRE, L. A. (1892) Simultaneous Dislocation of the First and Second Phalangeal Joints of the Middle Finger. New York Medical Journal 56: 379. SCHOLLE, W. (1931) Verrenkung zweier Glieder an dem gleichen Finger. Muencbener Medizinische Wochenschrift 78:1337-1338. SCHORCHER, F. (1932) Ausrenkung zweier Glieder an demselben Finger. Der Chirurg: 4: 150-151. BERENYI, P. (1957) Kettos ficam egy ujjon (double dislocation in one finger). Magyar Seb6szet (Budapest) 10: 167-9. 54
The Hand--Vol. 5
No. 1
1973
M U L T I P L E DISLOCATIONS OF A SINGLE F I N G E R
F R E D F. N A T H A N and A L L E N P, SCHLE1N, Chicago The treatment of dislocations of the proximal and distal interphalangeal joints of the finger are commonplace to any orthopaedic surgeon in practice. However, more than one dislocation occurring in a single finger seems to be an unusual occurrence. This fact was pointed out when we recently reviewed the literature after having been confronted with a double dislocation and, therefore, prompted us to report the case. CASE REPORT
A 44 year old policeman in the Chicago Police Force was playing baseball and sustained a dorsally directed injury to the tip of the right little finger. He had an obvious deformity of the little finger, with dorsal prominence of the middle and distal phalanges, and a double stepladder defect. The nerves and vessels were undamaged. The patient was reluctant to have the finger touched because of the pam. X-rays revealed a dorsal subluxation of the distal phalanx on the head of the middle phalanx; the middle phalanx was subluxated dorsally on the head of the proximal phalanx. Both dislocations were reduced with a 1% xylocaine block of the common digital nerve in the palm, and the finger was splinted on a malleable aluminium splint padded with foam. When seen two days later there was no gross deformity, although there was moderate swelling in and about the proximal and distal interphalangeal joints of the right little finger. The longitudinal splint was removed and a wrist gauntlet plaster cast, extending to the ring and little fingers, applied. The cast was left in place for two and a half weeks. The patient was then instructed to mobilise the hand. The joints were comfortable and minimally swollen.
Fig. 1 Patient on presentation to the emergency room with the double dislocation of the
little finger, with dorsal subluxation and ulnar deviation of the proximal joint.
52
The H a n d - - V o l . 5
No. 1
1973
Multiple Dislocations o] a Single Finger--Fred F. Nathan and Allen P. Schlein
Fig. 2 Initial splint applied after reduction of double dislocation. The patient was finally examined one month subsequent to injury, at which time he had 40 degrees of active flexion of the distal joint, and 60 degrees of active flexion of the middle joint. The hand was comfortable and function was good. X-rays showed good alignment and satisfactory position of the finger. DISCUSSION
A review of the literature revealed few descriptions of interphalangeal dislocations occurring simultaneously in one finger. The first description was in 1874 by Bartels who described a twenty-five year old female with a double dislocation. There was a single report in the English literature by Sayre in 1892 of a fiftythree year old carpenter who sustained a double dislocation. Subsequently there were two reports in German, one in 1931 by Scholle, describing a double dislocation of the ring finger of a fifty year old male, and one in 1932 by Sch~Srcher who described a double dislocation of a finger in a forty-three year old male. In 1957, Berenyi reviewed the literature and reported a single case of his own in the Hungarian literature. However, there does not appear to be a similar review published in the English literature. This would, indeed, appear to be a rare phenomenon. The treatment of a double dislocation is obviously no problem whatsoever. All cases reported have been easily reducible and, with splinting to allow soft tissue healing, seemed to do well. Some of the cases have been reduced under a local anaesthetic, some with no anaesthetic, and some with systemic analgesia. The mechanism of dislocation is agreed upon by the authors reporting. They all feel that the position of the hand at the time of the accident, along with the direction of force from volar to dorsalward determine the hyperextension initially of the distal joint. The forces are then not sufficiently dissipated, and a subsequent tear of the volar capsule of the proximal joint occurs, with hyperextension, causing the base of the middle phalanx to dislocate on the dorsum of the head of the proximal phalanx. By nature of the anatomical structure of the distal and middle joints, the greatest weakness appears to be on the dorsum. In addition, the contour The H a n d - - V o l . 5
No. 1
1973
53
Multiple Dislocations o/ a Single Finger--Fred F. Nathan and Allen P. Schlein
of the joint surfaces of the proximal and middle phalangeal heads appears to direct the dislocation dorsally SUMMARY
This report describes the case of a forty-four year old male with a double dislocation of the little finger. The treatment of this double dislocation presents no problem; however its rarity makes it worthwhile to be reported in the English literature. The mechanism and treatment are briefly discussed.
REFERENCES
BARTELS, M. (1874) Traumatische Luxationen. Archiv ft~r Klinische Chirurgie 16: 636-654. SAYRE, L. A. (1892) Simultaneous Dislocation of the First and Second Phalangeal Joints of the Middle Finger. New York Medical Journal 56: 379. SCHOLLE, W. (1931) Verrenkung zweier Glieder an dem gleichen Finger. Muencbener Medizinische Wochenschrift 78:1337-1338. SCHORCHER, F. (1932) Ausrenkung zweier Glieder an demselben Finger. Der Chirurg: 4: 150-151. BERENYI, P. (1957) Kettos ficam egy ujjon (double dislocation in one finger). Magyar Seb6szet (Budapest) 10: 167-9. 54
The Hand--Vol. 5
No. 1
1973