Clinical Science

DISLOCATION METACARPOPHALNGEAL JOINT

Fariz Auliadi Khalil, S. Ked

2006112018
Pembimbing:
dr.M. Bayu Rizaldy, M. Ked(Surg), Sp.OT

BAGIAN/ SMF ILMU BEDAH

FAKULTAS KEDOKTERAN UNIVERSITAS MALIKUSSALEH
RSUD CUT MEUTIA ACEH UTARA
Definition
The proximal interphalx joint (PIPJ) is the joint most
frequently exposed and frequently injured.

Dislocations in the proximal interphalx joint can be caused by

two basic mechanisms, namely avulsion or impaction shear.

Mechanism of avulsion or impaction shear can be caused by

hyperextension of the proximal interphalanx.

08/17/2021 2
Epidemiology
Fractures – dislocations of fingers in Indonesia are very
common. In 2012, the incidence of 68/1000 visits to the
emergency department was found. Meanwhile, the
prevalence of finger dislocation is 12/100,000 for a year.

In a study conducted by Chung et al. 2018, the contribution

of proximal interphalangeal dislocations was 5% in the
thumb, 10% occurred in the index finger, 14% occurred in
the ring finger and 24% occurred in the little finger.

08/17/2021 3
Etiology
The most common cause of joint dislocation is a fall.

Sports injuries that usually cause dislocations are soccer and hockey and sports that have a risk of falling, for
example: falling as a result of skiing, gymnastics, volleyball, basketball, and soccer players most often
experience dislocation of the hands and fingers due to accidentally catching the ball from other players.

Trauma that is not related to sports A hard impact to the joint during a motorcycle accident usually results in
dislocation, falling from stairs or falling while dancing on slippery floors.

The occurrence of 'tear' ligament and articular capsule which is a vital component connecting bones.

08/17/2021 4
Classification
Congenital Dislocation: occurs from birth due to a growth error, most commonly seen in the
hip.

Spontaneous or Pathological Dislocation: due to disease of the joints and/or tissues around
the joints. such as a tumor, infection, or bone osteoporosis. This is due to reduced bone
strength.

Dislocation of the elbow joint: injury is usually due to a fall on the hand which can cause
dislocation of the elbow joint posteriorly with the elbow clearly deformed with damage to the
joint protrusions of the elbow bones.

Finger joint dislocation: finger joints are easily dislocated and if not helped immediately the
joints will become stiff later. Finger joints can be dislocated towards the palms of the hands or
the backs of the hands.

Metacarpophalangeal and interphalangeal joint dislocations: these joint dislocations are

caused by hyperextension – extension of the joint.

08/17/2021 5
Patophisiology

the bone moves

tears the capsule /
compression of bone from its normal
causes the edge of
Injury which is pushed position. This state is
the glenoid to
forward known as a
avulsed
dislocation.

08/17/2021 6
Clinical manifestation
Acute pain,
Changes in joint contour,
Changes in limb length,
Joint deformities,
Changes in the axis of the dislocated bone,
Loss of normal mobility,
As well as impaired movement of the muscles,
Swelling and stiffness.

08/17/2021 7
Diagnosis
• Mechanism of injury
History • History of illness, drug usage, family illness

• InspectionDeformity, rotation, swelling

Physical Exam • Palpationtenderness, crepitus, distal vascularization and innervation
• MovementROM

Supporting • X-ray
• CT-Scan
Exam

08/17/2021 8
Treatment

1. Reposition immediately

2. Carefully manipulate the re-aligned joint surface.

This action is often performed under general
anesthesia to relax the muscles.

08/17/2021 9
 Small joint dislocations can be repositioned at the scene without
anesthesia, eg finger dislocations (in the shock phase), elbow The joint is supported by a plaster cast. For example in the
dislocations, shoulder dislocations. groin joint to provide healing for a stretched ligament.

Dislocations of large joints, such as the hip, require general anaesthesia. Reduction dislocations are returned to their original place
using anesthesia if the dislocation is severe.

Physiotherapy should be started immediately to maintain muscle The dislocated bone head is manipulated or returned to the
function and active exercise can be initiated early to promote full joint joint cavity.
motion, particularly in the shoulder joint.

Surgery should be performed if there are signs of severe neuromuscular The joint then mobilized with a splint, cast, or traction and
disturbance or if vascular compromise persists after gentle successful kept in a stable position, after reduction, gentle mobilization is
closed repositioning. Open surgery may be necessary, especially if the carried out 3-4 times a day to restore joint range.
soft tissue is pinched between the joint surfaces.

08/17/2021 10
Healing

Cell Callus
Hematoma Consolidatio Remodeling
Proliferation Formation
phase n Phase Phase
Phase Phase

08/17/2021 11
THANKS
Does anyone have any questions?
@corpus.visual
@rioa.k_