Finger Dislocation

I received a call a few days ago from someone sitting in the parking lot of a closed urgent care. He said his finger was bent at a crazy angle after playing some ball. Unfortunately, I was seated at a wedding, and during our conversation the music started suggested a groom en route! Terrible timing. So this one is for all you ball players.

Very few medical problems give me more joy than dislocation reductions, because very little that I do makes patients feel better that rapidly. Try to think of anything that moves patients from one extreme of pain and anxiety to another so quickly. Fingers, toes and patellas are tops, followed by shoulders. Elbows and hips are tougher, and often need sedation, so not nearly as enjoyable.

While it can be hard to differentiate between fractures and dislocations sometimes, the treatment paths are very often similar.

Red Flags:

• Bone through skin
• Lost sensation
• Lost perfusion
• Extreme pain

Happy Words

• “This happens all the time”
• “Doesn’t really hurt that bad, just looks jacked”
• “Just put it back in doc!… Go for it…I’m ready.”

In my early years of practice I had the impression that each of these limb deformities needed X-rays pre and post reduction. However, over time I’ve come to realize that the golden rule mandates a faster reduction. If I’m the patient, I absolutely do not want to wait around for a pre-reduction X-ray (and two X-ray bills!) If there’s a fracture so be it. That said, if a patient requests that first X-ray, I’m happy to oblige. I’m also happy to do a digital block to take the edge off.

For fingers specifically, a gentle, but firm pull to open the joint, followed by realignment, very often does the trick. For reductions in general, we say to “reproduce the accident in reverse.”

Please don’t call me irresponsible for instructing people to reduce their own fractures/dislocations. But if you’re ever stuck in a parking lot of a closed urgent care, with no Pre-R to come running, then put this on your list of options along with any ER.

After reduction, if no pain, with full range of motion, and normal sensation and perfusion, you can be pretty confident no fracture. And with a nice finger splint there’s time to X-ray at your leisure.

This first video is dull but informative: Dislocations Of The Finger – Everything You Need To Know – Dr. Nabil Ebraheim
These, however, had me in tears:(Language warnings.)
Dislocated Finger – Bizarre ER
How To Treat A Dislocated Finger At Home!! Great Exercises That Help…
Setting a dislocated pinky
(The youtube rabbit hole runs deep!)

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