An 8-year-old girl presented with an injury to the index finger of her dominant hand. Injury occurred while playing netball and presentation was on the day of injury. The distal interphalangeal joint was swollen and tender with a loss of active movement. Radiographs showed a physeal injury of the distal phalanx with an associated fracture split extending to the tip (Figure 1a and b ). The epiphysis was dislocated having slipped dorsally.
The patient was taken to theater soon after presentation and an attempt was made at closed reduction. Manipulation maneuvers failed and instead caused further rotation and displacement of the epiphysis. The joint was therefore opened dorsally through a cruciate incision to enable reduction. The epiphyseal fragment was found to be lying between the head of the middle phalanx and the extensor hood central slip. The articular surface was rotated nearly 180  and facing the fingertip (Figure 2a ). Some of the central extensor slip remained attached to the distal phalanx. Reduction occurred without significant force and was stable in flexion and extension. Therefore, no fixation was required (Figure 3a ). Radiographs taken at 6 weeks demonstrate some extension type displacement of the epiphysis (Figure 3b and c ). At 2 years, the radiographs illustrate premature fusion of the physis with a degree of malunion (Figure 4a and b ). Function at this stage was good and range of movement -5 to 50 degrees.