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Rotary PIP Subluxation

- Discussion:
    - usually presents as irreducible dislocation of PIP joint (as opposed to dorsal dislocations which are usually reducible);
    - rotatory dislocation involves buttonholing of one condyle of head of proximal phalanx through longitudinal rent in extensor hood between central slip and lateral band;
           - see: extensor mechanism of the digits

- Radiographs:
    - on lateral view, look for true lateral profile of proximal phalanx & oblique profile of middle phalanx;

- Non Operative Treatment:
    - with successful closed reduction, try buddy taping w/ full active ROM;
    - reduction:
           - traction is applied to finger while MP & PIP joints are flexed to 90 deg;
           - flexion relaxes volarly displaced lateral band, allowing it to slip back dorsally;
           - reduction is confirmed w/ post reduction true lateral;

- Open Reduction:
    - indicated with failure of closed reduction;
    - proximal phalanx condyle may be button holed between central slip & lateral band

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