Rotatory subluxation of proximal interphalangeal joint of the finger is a rare dislocation that can commonly be missed in a busy Emergency Department resulting in delayed treatment and bony ankylosis. We describe the radiological findings that will help in the diagnosis of this type of complex dislocation and its management. This case highlights the implications of this uncommon injury. Interposition of soft tissues makes this injury difficult to reduce by closed manipulation and open reduction may be indicated. If the condition is undiagnosed, the joint is likely to progress to soft tissue fibrosis and eventual bony ankylosis.