Version June 2024
| Preparation |
| 1. Remove all rings from the affected hand or foot. |
| 2. Assure no fractures or open joints are present on AP, true lateral, and oblique plain radiographs. |
| 3. Assemble all necessary materials: |
| Latex-free gloves |
| 1% buffered lidocaine without epinephrine (one part of 1 mEq/mL of sodium bicarbonate to 9 or 10 parts of 1% lidocaine) |
| Syringes (3 mL or 5 mL) and needles (25 or 27 gauge) |
| Povidone iodine solution (eg, Betadine) and alcohol |
| Scissors |
| White surgical tape |
| Splinting materials depend on the affected joint: |
| - Finger interphalangeal dislocations: padded, malleable, aluminum digital splint |
| - Metacarpal (thumb) dislocations: water, bucket, prefabricated splinting material (eg, plaster of Paris or fiberglass) OR Webril, plaster of Paris, and stockinette to fashion a thumb spica splint |
| 4. Provide appropriate analgesia as determined by the patient's age and degree of pain. |
| Interphalangeal reduction |
| Have an assistant brace the hand or foot. |
| Reduce the dislocation using one of the following methods: |
| Dorsal dislocation: Provide longitudinal traction; gently hyperextend the joint while pushing the base of the dislocated phalanx into place. |
| Volar dislocation: Provide longitudinal traction; gently hyperflex while pushing the base of the dislocated phalanx into place. |
| Lateral dislocation: Provide longitudinal traction; gently hyperextend the joint while correcting the ulnar or radial deformity. |
| Test joint stability throughout full range of motion of the digit to ensure that the joint will recover well with splinting alone. |
| Obtain a post-reduction plain radiograph, including a true lateral view of the digit. |
| Interphalangeal immobilization |
| Immobilize the digit based on the location and type of dislocation: |
| DIP dorsal or lateral finger dislocation: Splint the DIP in full extension while allowing full range of motion of the PIP joint. |
| PIP dorsal or lateral finger dislocation: Apply a dorsal splint with the PIP in 20 to 30 degrees of flexion. |
| Volar finger dislocation: Splint the PIP and DIP in full extension. |
| DIP or PIP toe dislocation: Buddy tape the affected digit to its neighbor. |
| Simple metacarpophalangeal dislocation |
| Reduction: |
| Have an assistant brace the hand and flex the wrist. |
| Avoid excessive hyperextension or distraction that can convert a simple dislocation into a complex dislocation. |
| Gently distract the affected thumb or digit and apply volar pressure to the base of the dislocated proximal phalanx. |
| Test joint stability throughout the full range of thumb or finger motion to ensure that the joint will recover well with splinting alone. |
| Immobilization |
| Finger dislocation: Splint the digit in 90 degrees of flexion. |
| Thumb dislocation: Apply a thumb spica splint with the MCP joint in 20 degrees of flexion. |
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