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Double dislocation of finger interphalangeal joints
Saqib Aziz Jahangiri1, Prabhakar Mestha, Scarlett McNally
1Department of Orthopaedics and Trauma, Eastbourne District General Hospital, Eastbourne, UK. sajahangiri@hotmail.com
BMJ Case Reports
|October 25, 2012
Summary
A nursing home resident experienced an unwitnessed left little finger injury, resulting in a double dislocation of the proximal and distal interphalangeal joints. Surgical intervention and immobilization were performed to manage the complex finger injury.
Area of Science:
- Orthopedic Surgery
- Trauma Care
- Geriatric Medicine
Background:
- A 62-year-old male patient with dementia residing in an Elderly Mentally Infirm (EMI) nursing home presented with an unwitnessed left little finger injury.
- The patient was admitted via the Accident & Emergency (A&E) department.
Observation:
- Examination revealed a swollen, deformed left little finger with a volar laceration exposing the proximal phalanx head.
- Distal sensation and capillary refill were normal.
- X-rays confirmed a double dislocation of the proximal and distal interphalangeal joints.
Findings:
- Initial management included reduction of the dislocation under ring block anesthesia and wound irrigation.
- Surgical exploration, washout, and wound closure were performed under general anesthesia.
- The finger was immobilized using neighbor strapping and bandaging in flexion.
Implications:
- This case highlights the importance of prompt diagnosis and management of complex finger dislocations, even in patients with cognitive impairment.
- Effective treatment involves reduction, thorough wound care, and appropriate immobilization to ensure optimal outcomes.
- Consideration of patient's overall health status, including dementia and nursing home residency, is crucial in treatment planning and follow-up.
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