Reduction - Finger dislocation
This procedure is generally performed using a ring block with local anaesthesia (covered separately)
Contraindications (absolute in bold)
Life or limb-threatening injuries
Reduction by orthopaedic team in emergency department
Reduction in operating theatre
Consent is not required if the patient lacks capacity or is unable to consent
Brief verbal discussion is recommended if the situation allows
Less complex non-emergency procedure with low risk of complications
Failure (of reduction, recurrence or immobilisation)
Conversion to an open injury
Aseptic non-touch technique
PPE: non-sterile gloves
Any clinical area
Syringes and needle (25-27g) for ring block
Splinting material for POSI splint or aluminium digital splint
Supine head up at 45 degrees
5ml lignocaine 1% without adrenaline
Sequence (basic overview)
Examination for other injuries and fractures
Neurovascular assessment of finger (sensation)
Perform a digital nerve block to the affected finger
Obtain X-ray of the finger (assess fractures)
Apply sustained traction to distal digit while exaggerating distal deformity (consider gauze to aid grip)
Apply pressure to proximal end of dislocated bone towards joint (maintaining traction)
Consider flexion of the wrist (relax flexors) or extension of the wrist (relax extensors)
Consult orthopaedic team after two failed reduction attempts
Check X-ray, circulation and limb function:
Reassess neurovascular status (sensation and capillary refill)
Assess joint stability with movement of joint (hyperextension, ulnar and radial stress)
Assess rotational deformity with movement of joint (no digital overlap, nailbeds point to thenar eminence)
Obtain post-reduction finger X-ray and confirm satisfactory reduction
Volar dislocation: dorsal splint in mild flexion
Dorsal dislocation: volar splint in extension
Lateral dislocation: buddy strapping
MCP dislocation: POSI splint
Thumb dislocation: thumb spica splint
Tetanus (ADT) and antibiotic cover (cefazolin 2g IV) for open wounds
Discuss follow-up and length of immobilisation with orthopaedic or hands team
Document procedure, neurovascular assessments, X-ray findings and management plan
Search for other fractures and serious injuries when treating a dislocated joint
Always perform a neurovascular exam before and after a relocation attempt
Reassurance, verbal distraction, and effective pain relief all aid successful joint relocation
Slight traction distal to the dislocation is often enough to relocate the joint
Orthopaedic consultation prior to reduction for associated fractures, open dislocations, thumb dislocations
This guide has been simplified for general application to all digital dislocations. Difficult reduction should always prompt orthopaedic discussion and only experienced providers should attempt thumb reduction without orthopaedic discussion.
Thumb dislocations are often associated with complications. Carpometacarpal thumb dislocations are associated with unstable fractures, metacarpophalangeal thumb dislocations may be irreducible due to volar plate entrapment which can lead to fracture if reduction is attempted.
Most digital dislocations with require local anaesthetic for reduction but some will reduce easily, producing immediate relief of discomfort and resolution of the deformity. We suggest reduction may be attempted without anaesthesia at time of injury or initial assessment. If pain impedes reduction, local anaesthetic ring block should be applied, and an X-ray performed before further attempts.
This guideline has been reviewed and approved by the following expert groups:
Emergency Care Institute
Please direct feedback for this procedure to ACI-ECIs@health.nsw.gov.au.
Roberts JR, Custalow CB, Thomsen TW. Roberts and Hedges’ clinical procedures in emergency medicine and acute care. 7th ed. Philadelphia, PA: Elsevier; 2019.
Dunn RJ, Borland M, O’Brien D (eds.). The emergency medicine manual. Online ed. Tennyson, SA: Venom Publishing; 2019.
In: UpToDate. Waltham (MA): UpToDate. (2019): Digit dislocation reduction
Skinner H. Current diagnosis & treatment in orthopaedics. 5th ed. New York: McGraw-Hill Medical; 2013.
Borchers JR, Best TM. Common finger fractures and dislocations. Am Fam Physician. 2012;85(8):805-810.