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Irreducible volar dislocations of the proximal interphalangeal joint
  1. N V Deshmukh,
  2. S V Sonanis,
  3. J Stothard
  1. Accident and Emergency Department, North Tees General Hospital, UK
  1. Correspondence to:
 Dr N V Deshmukh
 8 Albert Street, Haverfordwest SA61 1TB, UK;

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Volar dislocations of the finger proximal interphalangeal joint (PIPJ) is a very rare injury. It is often missed in accident and emergency (A&E) and is chronic and irreducible when first seen in the hand clinic. Intrarticular entrapment of the extensor tendon may render close reduction difficult. We report three cases, all sent home from the A&E department, one in the thumb. A good outcome was obtained in these cases with early intervention.


A 20 year old athlete sustained a twisting injury to his left thumb while on a skiing holiday. He had the skiing stick in his left hand and the stick got stuck, his left thumb still being held in the leather loop of the stick sustaining this injury. On examination the interphalangeal joint (IPJ) was swollen and tender. Active flexion was possible but extension was weak and painful. Valgus stress was positive in extension. Radiographs showed mild subluxation of the IPJ. After attempts to close reduce the IPJ failed open reduction was performed. The ulnar collateral ligament was ruptured completely and on valgus stressing the extensor tendon was seen entrapped in S shaped in the IPJ (fig 1). A hook was inserted pulling the tendon and the joint was reduced. The capsule and the collateral ligament was repaired. The thumb was immobilised in 20 degrees of flexion. After two weeks mobilisation was started. This patient made an uneventful recovery.

Figure 1

 Diagrammatic illustration of ulnar collateral ligament rupture and interposition of EPL tendon (case 1).


A 28 year old carpenter was referred two days after injury with pain, swelling, and …

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