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Một người đàn ông 43 tuổi bị bắt ngón tay trái của mình ở nút áo của đồng nghiệp và con số các cách mạnh mẽ lệch ulnarward. Ông cảm thấy một snap, và nhận thấy một biến dạng góc thông qua interphalangeal gần (PIP) doanh và không có khả năng hoàn toàn mở rộng các ngón tay. | FRACTURES AND DISLOCATIONS OF THE HAND 46 Lateral Dislocations of the Proximal Interphalangeal Joint Christopher H. Martin and Steven Z. Glickel History and Clinical Presentation A 43-year-old man caught his left small finger in the coat button of a coworker and the digit was forcefully deviated ulnarward. He felt a snap and noticed an angular deformity through the proximal interphalangeal PIP joint and an inability to fully extend the finger. Diagnostic Studies Radiographic evaluation in the emergency room showed a lateral dislocation of the proximal interphalangeal joint Fig. 46 1 . Initial clinical examination showed sensory function to be intact on both sides of the digit with brisk capillary refill. A digital block was placed and the dislocation was reduced with gentle longitudinal traction. Radiographic examination confirmed a concentric reduction of the PIP joint with a symmetric joint space. PEARLS While the patient is under digital block at the time of reduction assess the integrity of the central slip insertion by resistance to PIP flexion with the MP joint flexed. Begin motion as early as patient comfort will allow. Assure a concentric reduction incarceration of the collateral ligaments within the joint will preclude their healing at an appropriate length. PITFALLS Boutonniere deformity Stiffness Laxity Physical Examination While still anesthetized the finger was examined to assess stability of the joint and integrity of the extensor system. The patient was able to actively move the digit through a full range of motion. There was no subluxation noted. The integrity of the extensor mechanism and central slip insertion was then tested by having the patient extend the PIP joint against examiner resistance with the metacarpophalangeal MP joint flexed. There was full extension with normal strength compared with the uninjured digit. The digit was splinted with the PIP joint in full extension. The patient was seen weekly for the next 2 weeks with radiographs .
