Abstract
A 24-year-old, right-handed man injured his left thumb while sliding into another player in softball. He was brought to the emergency room with a clean, palmar wound at the thumb IP flexion crease. The flexor pollicis longus (FPL) tendon was in the midline, draped over the proximal phalanx condyles. The thumb distal phalanx was displaced dorsal to the proximal phalanx. Active flexion was not possible. X-ray examination showed a dorsal dislocation of the thumb IP joint, with a sesamoid located between the palmar aspect of the distal phalanx base and the dorsal cortex of the proximal phalanx neck (Fig. 1). A closed reduction using a digital block for anesthesia was not successful. Under digital block, the palmar wound was explored. The FPL tendon and the neurovascular bundles were intact. When the FPL tendon was retracted radially, the distal phalanx base could be seen to rest on the dorsal aspect of the proximal phalanx head. Extension of the distal phalanx showed the palmar plate to be attached to the distal phalanx base and displaced dorsally. The sesamoid was found attached to
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