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Case 266

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A 43-year-old female patient attends an orthopedic clinic due to a fall from orthostatic position, with trauma in the fourth left dactyl. Complains pain and edema since the moment of trauma, deformation in the injured finger and difficulty of movement. Simple X-rays of the left hand were performed on posteroanterior and anterior internal oblique incidences, soon after the fall, in the emergency room.

Once analyzing the clinical case and the images presented, what is the best immediate approach?

a) Surgical treatment

25%

b) Request complementary radiological incidence

25%

c) Conservative treatment

25%

d) Request computed tomography

25%
   

Image analysis:

Image 1 - Analysis: Simple X-ray of the left hand, posteroanterior incidence, demonstrating indefinition of the limits of the articular surfaces of the proximal interphalangeal joint of the fourth finger.

Image 2 - Analysis: Simple X-ray of the left hand, anterior internal oblique incidence. Demonstrating partial misalignment of the components of the proximal interfacial joint of the fourth finger (in red), compatible with dislocation.

Highlights:

- Dislocations are bone slip out in a joint. In relation to the proximal interphalangeal joints, the dislocations are classified as dorsal, palmar and lateral;

- The main signs and symptoms are edema, pain, deformity and reduced mobility of the affected joint;

- The diagnosis is based on anamnesis, physical examination and imaging tests.

- The initial imaging evaluation involves simple radiographies of the hand in at least three incidences: posteroanterior, anterior internal oblique and profile;

- Treatment should be immediate, consisting of reduction of dislocation;

-  Complications such as permanent deformity, loss of mobility and new dislocations, are related to delayed treatment.

References:

- Leggit JC, Meko CJ. Acute finger injuries: part II. Fractures, dislocations, and thumb injuries. Am Fam Physician 2006; 73:827.

- Borchers JR, Best TM. Common Finger Fractures and Dislocations. American Family Physician, 2012; 805-10.

- Jahangiri AS, Mestha P, McNally S. Double dislocation of finger interphalangeal joints.  BMJ Case Reports 2012;1-3

- Joshi SV. Digit dislocation reduction. UpToDate; 2017. Available in https://www.uptodate.com/contents/digit-dislocation-reduction?source=search_result&search=dislication%20finger&selectedTitle=1~150. Accessed in 04 jan 2017.

Author:

Ana Carina Breunig Nunes, 6th year medical student at Universidade Federal de Minas Gerais

E-mail: anacbreunig[at]gmail.com

Supervisor:

Leonardo Braga Gonçalves MD, Orthopedist

E-mail: drleobg[at]hotmail.com

Reviewers:

Luísa Bernardino, Juliana Albano, professor José Nelson Vieira and professor Viviane Parisotto.

Translated by:

Giovanna Vieira Moreira, 5th year medical student at Universidade Federal de Minas Gerais.

E-mail: giovieiramoreira[at]gmail.com

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