Volar PIP Dislocation     


- Discussion:
    - rare injury caused by compression and rotation with PIP joint flexion;
    - may occur as simple dislocations or fracture dislocations;
    - it is often unstable and irreducible;
    - volar dislocation involves disruption of central slip, along w/ collateral ligaments and palmar plate;
    - development of boutonnere deformity is one complication;

- Reduction:
    - traction and manipulation of the middle phalanx is carried out while MP joint is held in flexion;
           - MP joint is held in flexion prior to reduction inorder to relax the lateral bands;
    - difficult reduction may be due to entrapment of lateral bands around the volar aspect of the proximal phalanx;

- Non Operative Treatment:
    - following reduction, test ability to actively extend joint;
    - if pt can extend joint past 30 deg of of full extension, then apply dorsal splint;
    - keep PIP joint in full extension but allow DIP to remain free;
    - hence, these are treated similar to boutonnere injuries;
    - splinting continues for 3-4 weeks, followed by night splinting for 3 weeks;
    - dorsal lip frx:
           - up to 2 mm of frx separation may be permitted, but more separation results in extensor mechanism separation;

- Operative Treatment:
    - dorsal approach over PIP joint, w/ a gentle curve across the joint;
    - incision proceeds between the lateral bands and central slip;
    - involves relocation of the lateral bands, reduction of the joint, and repair of the central slip;
    - reduction is held in place with a K wire;
    - if a fracture fragment is present it may be fixed w/ 0.28 K wire;
    - dorsal lip frx:
           - more than 2 mm of frx separation requires ORIF and early ROM:

     

- Complications:
    - boutonnere injury;
    - psuedo-boutonnere injury:
          - involves contracture of volar capsule;
          - look for calcification of volar capsule on lateral views



Anterior dislocation of the proximal interphalangeal joint. A cause of rupture of the central slip of the extensor mechanism.

Volar dislocation of the proximal phalangeal joint. Thompson JS and Eaton RG. J Hand Surg. 1977;2:232.



Original Text by Clifford R. Wheeless, III, MD.

Last updated by Data Trace Staff on Thursday, October 4, 2012 11:58 am