Hand and Wrist Dislocations
A dislocation is an injury where the two bones that meet at a joint become separated, so that they no longer sit together. In many instances the injury occurs during sport and it is not uncommon for the dislocation to be reduced (relocated) by an athlete, trainer or coach.
How are dislocations assessed?
Finger joints are commonly reduced in a hospital emergency department with local anaesthetic used to numb the finger. Occasionally the joint can't be reduced in the emergency department and an operation is required. It is good practice to have an X-ray before and after a joint is relocated, so that any fracture can be identified.
After the joint is relocated it is important to check the stability of the collateral ligaments, to see if the finger bends to the side in an abnormal manner. If the collateral ligaments have also been injured this will need to be taken into consideration when planning treatment and rehabilitation.
Sometimes when a joint dislocates the skin overlying it tears open. If this occurs it is necessary to have antibiotic treatment and an operation to wash out the joint, because bacteria from the skin or environment can infect the joint and cause major problems.
My x-ray shows a fracture
Minor fractures often occur with finger dislocations. These small fractures (termed "avulsion fractures") can occur if a stretched ligament pulls off a fragment of bone where it inserts (this is especially common with a volar plate injury). Most of these minor fractures do not require surgery.
Sometimes hand injuries that cause a dislocation will also create a more significant fracture at the same location. These injuries commonly require surgery to maintain the bones in the proper position while they heal and to restore hand function.
Treatment for dislocations often includes treatment of swelling, specific exercises, splinting and buddy-strapping.
What are the possible complications?
The main complications from joint dislocation are instability (where the joint is too mobile), stiffness (where the joint is not mobile enough) and rarely post traumatic arthritis. Patients are often surprised that their joint is still swollen 2-3 weeks later, but this is actually not surprising because it is a significant injury that usually involves significant bleeding into the joint and bruising of ligaments and soft tissues. Hand therapy plays a crucial role in reducing swelling and achieving a normal range of joint movement.
Photo Credit: Twitter Account @tomsteinfort