Dorsal Subluxation of the Distal Interphalangeal Joint

Diagnostic Workup

Obtain at least 3-view radiographs immediately to assess fracture pattern, displacement, and articular involvement, as recommended by the American College of Radiology 1, 2
Identify key radiographic findings, including volar base fracture fragments, degree of dorsal subluxation, and articular surface involvement, with ≥1/3 involvement indicating surgery 2, 3
Measure the interfragmentary gap, with >3mm indicating surgery 2
Use MRI if flexor tendon avulsion is suspected, with 92-100% sensitivity for detecting tendon injuries and level of retraction 2
Dynamic ultrasound can directly visualize DIP joint malalignment in the absence of fracture, as suggested by the Journal of the American College of Radiology 4, 5

Attempt closed reduction first for simple dislocations without large fracture fragments, applying ice-water mixture for 10-20 minutes with thin towel barrier, and never attempt manual straightening before proper evaluation, as recommended by the American Academy of Orthopaedic Surgeons 3
Splint in position found until definitive treatment, with surgical indications requiring immediate referral for avulsion fractures involving ≥1/3 of articular surface, interfragmentary gap >3mm, displacement >3mm, and palmar subluxation of distal phalanx with irreducible subluxation 2, 3

Rigid immobilization for 3-6 weeks followed by aggressive early motion is mandatory, with removal of K-wire at 4-5 weeks when fracture union is confirmed, and beginning active finger motion exercises immediately after immobilization to prevent stiffness, as recommended by the American Academy of Orthopaedic Surgeons 2, 6
Home exercise programs moving fingers through complete range of motion are effective, and uninterrupted immobilization is essential, as suggested by the American College of Radiology 2, 3

Realistic functional expectations after volar plate arthroplasty include average DIP arc of motion and residual flexion contracture, with full flexion typically achievable without extension lag 2
Unremitting pain during follow-up warrants immediate re-evaluation for inadequate fixation, pulley system injury, and tendon adhesions or re-rupture, as recommended by the American College of Radiology 2
Arthrodesis is the recommended salvage procedure for failed DIP joint reconstruction, as arthroplasty is reserved for PIP joints, according to the Annals of the Rheumatic Diseases 7