Before reduction, offer the patient a digital nerve block. The technique shown here is the webspace approach (additional techniques described in a separate video).

The reduction technique makes sense when you review the x-ray. First, brace the finger at the proximal phalanx to provide countertraction. Second, pull axial traction to disengage the middle phalanx from the proximal phalanx. Third, pull the middle phalanx back into place while extending the finger. This same concept is used for a dorsal or lateral dislocation.

After reduction check for full range of motion of the finger, which might be a little limited due to pain and swelling. This includes checking for lateral stability and also checking the flexor digitorum tendons (described in more detail in a separate video).

Both of the patients shown actually had anterior dislocations which are high risk for a central slip tendon injury and an Elson test should be performed (described in more detail in a separate video).

Sprinting recommendations are as follows:

Volar dislocations - splint in extension for 3 weeks.

Dorsal dislocations - either splint in 30° of flexion for 2-3 weeks or buddy tape for 2-3 weeks if stable.

Lateral dislocations - buddy tape for 2-3 weeks.

Close hand surgery follow up is recommended.

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