Open dorsal distal interphalangeal joint dislocations: A report of 20 cases

Abstract

IntroductionSeveral isolated closed dislocations of the dorsal interphalangeal joint are reported, and sometimes they may be associated with other fractures/dislocations. Less is known about the open dorsal dislocation of the distal interphalangeal joint. HypothesisOpen dorsal dislocations are stable after reduction and prone to develop dorsal interphalangeal joint stiffness. MethodsTwenty patients with open dorsal dislocation were treated by open reduction and volar plate repair. The diagnosis was made, and the displacement was noted. Associated injuries, fractures, and dislocations were also reported. Postoperative x-rays, range of movements, visual analog score, return to work, and functional outcomes were analyzed. ResultsThe average follow-up was 23months (range: 19–27months). There were dorso-radial (n=13), dorsal (n=5) and dorso-ulnar (n=2) dislocations. Follow-up with radiographs showed good reduction and congruent distal interphalangeal joint. The mean range of DIP joint movement was 53% (range: 40–65%) and grip strength 70% (range: 50–76%) of the opposite side. The Median VAS score was 0.6 (range: 0–2). Seventeen out of 20 patients who were operated on<8hours of injury had a significant impact on the functional outcome (p<0.05). Three patients who had treatment delay>8hours of injury developed significant postoperative joint stiffness. DiscussionAdequate debridement and an early open reduction of the dorsal interphalangeal joint dislocation produces stable and congruent joint with good functional outcome and early return to normal activities. Open dislocations do not behave like closed dislocations, and joint stiffness is more common and inevitable. Level of evidenceIV; retrospective case study.