Irreducible volar dislocation of the proximointerphalangeal joint

Volar dislocations of the proximointerphalangeal joint are not injuries to be treated lightly. If the dislocation reduces easily, a tear of the central tendon would be indicated and immediate open repair of this structure then becomes mandatory. If the dislocation is irreducible, then a tear of the collateral ligament with button-holing of the head of the proximal phalanx through the interval between the central tendon and the lateral band should be suspected, and open reduction and replacement of these structures in their normal position is indicated. The results after open repair of irreducible dislocations may be more favorable than dislocations that reduce easily. The extensor mechanism is intact and as the joint need not be held for long periods of time, motion can be started early and stiffness avoided.