• Matthew J Pirotte, James Saucedo, and Danielle McCarthy.
• Department of Emergency Medicine, Northwestern Memorial Hospital, Chicago, IL, USA. m-pirotte@md.northwestern.edu
• Am J Emerg Med. 2012 Jul 1;30(6):1016.e1-2.

AbstractDislocations and subluxations at the metacarpal-phalangeal joint are rare and volar or palmar subluxations represent a small fraction of these. A 54-year-old man presented with an injury to his right hand; he had heard a pop while putting down a weight. He had normal vital signs, and his examination revealed a deformity at the third metacarpal-phalangeal joint. Plain radiographs did not reveal a fracture. The diagnosis of volar subluxation was made after consultation with a hand surgeon. Attempts at closed reduction in the emergency department were unsuccessful, and he was splinted with plans for follow-up. There are several characteristics of this injury that present a diagnostic challenge: most patients are able to make a fist due to intact flexor mechanism, the deformity is subtle and may be masked by swelling, and lateral radiographs tend not to image the joint well. Recognition of this injury and hand surgery consultation are essential because most described cases required open reduction.

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