Stepladder Dislocation of the Finger
A 54-year-old woman presented to the emergency department with a crooked, painful finger after she had fallen backward onto her outstretched hand 1 hour earlier. On physical examination, dorsal displacement of the right fifth (“pinky”) finger was noted at the proximal and distal interphalangeal joints. The patient was unable to move the finger. There were no signs of neurovascular compromise. Radiographs of the right hand showed dorsal dislocation of the proximal and distal interphalangeal joints of the fifth finger, which created a “stepladder” shape (Panel A, lateral view; Panel B, posteroanterior view). A diagnosis of simultaneous dislocation of the proximal and distal interphalangeal joints of the fifth finger was made. Although dislocation of an interphalangeal joint is commonly seen, simultaneous dislocations within the same finger are rare. Treatment with closed reduction and splinting of the finger was provided. Three weeks after reduction, the splint was removed and the patient was counseled to resume an active range of motion with the finger without weight-bearing for 4 additional weeks. At the 6-month follow-up, the patient had full function of the finger.