Hand > Finger Dislocation > Treatments

   Open Reduction, Stabilization

Treatment Introduction

Based on the nature and location of your finger dislocation, your physician may inject a local anesthetic directly into your finger or hand to aid in performing a closed reduction. Once this has been done, the joint will be reduced, or placed back in its normal position, by putting gentle pressure on the joint and moving the parts together. After a closed reduction has been performed, the joint still may be unstable. If this is the case, it may need to be stabilized using external pins or wires that are passed through the skin and fixed to the finger bones.

The decisions you make and the actions you take before surgery can be every bit as important as the procedure itself in ensuring a healthy recovery.

   Getting a second opinion from another qualified surgeon is often advisable, particularly in rare or unique cases.

   Make sure you have received any equipment you will need when you get home from the hospital. You should receive prescriptions for these items from your doctor when your surgery is scheduled.

   Learn the potential risks and benefits of the surgery by asking your surgeon any questions that will help you better understand the procedure. It can also help to talk to someone else who has undergone the same surgery.

   Any physical problems, such as a fever or infection, should be reported to your surgeon, and you should notify your surgeon of any medication you are taking.

   To reduce the risk of infection, improve healing, and decrease complications, try to quit smoking or decrease the amount you smoke. In general, smokers have a higher infection and complication rate overall.

   To check if the orthopedist performing the surgery is board-certified or eligible, call the American Board of Orthopaedic Surgery at 919-929-7103.

At most medical centers, you will go to "patient admissions" to check in for your closed reduction and stabilization. There may be separate check-in areas for ambulatory outpatient (patients who go home the same day after surgery) and for overnight inpatient surgery. Be sure to ask your physician or an assistant about this. After you have checked in to the hospital or clinic, you will go to a holding area where the final preparations are made and the paperwork is completed. You will wear a hospital gown and, if applicable, remove your watch, glasses, dentures, and jewelry. You will have the opportunity to speak with your orthopedic surgeon or an assistant, and meet the anesthesiologist or anesthetist (a nurse who has done graduate training to provide anesthesia under the supervision of an anesthesiologist). Then, you will be taken to the operating room. Here are some important thigns to remember for the day of your surgery:

   You will probably be told not to eat or drink anything after midnight on the night before your surgery. This will reduce the risk of vomiting while you are under anesthesia.

   Because you may be unable to drive, arrange for someone to help take you out of the hospital and drive you home when you are released.

   Take it easy. Keeping a good frame of mind can help ease any nerves or anxiety about undergoing surgery. Distractions such as reading, watching television, chatting with visitors, or talking on the telephone can also help.

The surgical procedure to repair a dislocated finger is usually performed under a regional anesthetic, which means your are given a numbing medicine to make your hand or arm go to sleep. You can stay awake for the procedure or receive medicine to relax. If enough relaxing medicines are given you can fall asleep so that you do not have any memory of the actual procedure. The procedure depends on the severity of the dislocation. If it is a dislocation without bony involvement an incision is made and the structure blocking the reduction which is either a ligament or tendon is moved so that the joint can be placed across the joint to prevent re-dislocation for the first 1-2 weeks.

   If a fracture is associated with the dislocation the fracture may be fixed with pins or screws after the bone is put back into position. If the fragments are to small to allow fixation there fragments may be removed and the ligament in front of the joint (volar plate) is advanced into the bone with stitches. This is called a volar plate arthroplasty. Motion is started three weeks after the procedure.

   When more than 50 percent of the joint is destroyed by fractures, a volar plate arthroplasty may not work as well. In this case an external fixator may be placed across the joint to hold it in place. This entails placing two pins into the bone before the joint and after the joint and connecting it with a bar. This device allows the bones to be held in proper alignment while the surrounding tissue heals. It remains in place for 3-5 weeks and motion can be started immediately after the procedure while the device is in place.

   If the joint is completely destroyed an artificial plastic joint may be inserted with immediate motion. This usually requires immobilization of the finger for 4-6 weeks.

   Some joints can not be replaced with artificial joints. In these cases, the two bones are held together to allow them to heal together. This is called a fusion. After a joint has been fused it will not move but this alleviates pain and deformity. It usually requires immobilization for four to six weeks to allow the bones to heal together.

You usually spend 1-2 hours in recovery room waiting for the medicine that relaxed you to wear off. The more sedation that you receive, the longer you will spend in recovery after the procedure. Most doctors also use numbing medicine so that your hand may be numb when you awake. The numbing medicine can last for 2-6 hours. When the numbing medicine wears off, the pain begins and you are given medicine by mouth to reduce your discomfort.

Home recovery

After closed reduction of a finger dislocation, the length of time that you will need to keep the splint on varies according to the severity of your injury and which finger joint is affected. In some cases, the splint is adjusted at weekly intervals to reduce the degree of flexion so that the finger can be fully extended after four to six weeks. You should return to the doctor approximately 8-10 days after the procedure to have the stitches removed. A metal pin may be placed across the joint to protect the ligament for 3-5 weeks. During this time you can not get the area wet. When taking a shower you can place a large plastic bag on your arm with a rubber band at the top part of your arm. Hold your elbow over your head so that water does not role down your shoulder and into the bag. Commercially-made bags, which function in a similar way, can be purchased at a surgical supply store. The pin is removed in the office and motion and sometimes an occupational therapy program is initiated. It generally takes 6-12 weeks to restore a functional range of motion. You may begin driving when you feel the hand is strong enough to grip the steering wheel.

Rehabilitation

Following closed reduction and stabilization of a finger dislocation, your physician will usually suggest that you begin a program range of motion exercises as soon as possible. These can be performed with the splint on, and should be continued even if slight swelling and stiffness occurs during the first few weeks. In some cases where the finger joint remains painful, a steroid injection may be required. The splint usually remains on for 3-6 weeks, depending on your specific injury. After the splint is removed, your physician may recommend buddy taping, in which the injured finger is taped to an adjacent finger. Depending on the severity of your injury, return of full joint motion can take as long as several months. During this time swelling and stiffness may recur. In many cases, however, athletes who have suffered finger dislocations have been able to return to their sports within a few weeks while the finger is still in the splint or is buddy-taped. This should be done only after consultation with your physician.

Though finger dislocations are contact injuries that often cannot be avoided, you can take steps to minimize your risk of suffering a dislocation. If you play contact sports such as football, hockey, or lacrosse, make sure you wear padding that protects your hands and fingers. Never use old, worn-out pads that have lost their stiffness. Maintaining hand and finger strength and coordination also can help prevent some finger injuries. Ask your physical therapist for a specific program of exercises.