- See:
-
Differential Dx of PIP Injuries:
-
Fracture Dislocations of the PIP Joint:
-
Phalangeal Injury
- Discussion:
-
anatomy of the injury:
- volar plate is always detached (usually
from middle phalanx) in PIP dorsal dislocations;
- distal avulsion of volar plate in dorsal PIP dislocations makes entrapment of plate w/in the joint
unlikely (in contrast to MP joint in which
complex dorsal dislocations prevent closed reduction);
- an irreducible dislocation of PIP joint is probably
rotary PIP subluxation:
- volar plate maintains its attachmnets to the proximal phalanx & its lateral attachments to the accessory collateral ligament;
- collateral ligaments may also be ruptured at the time of injury;
-
classification of acute injuries:
-
type I - hyperextension injury
- volar plate avulsion from middle phalanx base, ligament split, and the joint surface intact;
- finger immobilized in a dorsal splint w/ 20-30 deg of flexion for 10 to 21 days;
- after 2-3 weeks, start on an active flexion program using buddy tapping;
-
type II - dorsal dislocation
- major ligament injury
- finger immobilized in a dorsal splint w/ 20-30 deg of flexion for 10 to 21 days;
- after 2-3 weeks, start on an active flexion program using buddy tapping;
-
type III:
fracture dislocation:
- proximal dislocation w/ the middle phalanx sheared away;
- stable - small fracture w/ less than 40% of the middle phalanx base
- unstable - frx fragment involves > 40% of joint surface;
- try to closed reduction, placing the joint in 75 deg flexion;
- w/ congruent reduction, reduce amount of flexion over over 4 to 5 weeks;
-
chronic PIP dorsal dislocations:
- leads to chronic volar plate laxity and hyperextension deformity;
- may interfere with finger f(x) or result in
swan neck deformity;
- operative treatment:
- requires advancement and
reattachment of volar plate;
- plication of local tissue;
- reconstruction of collateral ligament & volar plate;
- Reduction & Treatment:
- hyper-extension, traction, and then gentle flexion will usually allow reduction;
-
simple dislocations:
- early protected ROM allows earliest return to full function and prevents stiffness;
- most patients will require immobilization for up to one week until majority of the pain subsides;
- once patient can tolerate digit range of motion, then the digit should be buddy tapped and allowed full ROM;
-
fracture - dislocations:
- extension block casting:
- if collateral ligaments are intact, the reduction will be stable;
- early mobilization w/ buddy tapping w/ limited extension for 3-6 weeks is sufficient for stable fractures;
- external fixation:
-
volar plate arthroplasty:
- if joint is unstable due to collateral ligament disruption, consider direct repair of collateral ligament as well as volar plate;
Chip Avulsions and Ruptures of the Palmar Plate in the PIP
Fracture dislocations of the proximal interphalangeal joint.
TR Kiefhaber et al.
J. Hand Surg.
Vol 23-A. No 3. May 1998. p 368.
