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PIP Joint Fracture-Dislocation

63 citationsUpdated Sep 2026
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For patients: a plain-language version of this topic is available. See the patient guide.

Overview

PIP joint fracture-dislocations present a complex clinical challenge where treatment decisions are driven by joint stability, fracture fragment size, and associated soft tissue injuries [2]. Clinical outcomes are often difficult to predict due to the variability of fracture patterns and the potential for sub-acute or chronic presentations [7]. While PIP joint fractures generally yield satisfactory outcomes, with 50% of DIP joint fractures showing only fair or poor results in comparative contexts [8], soft tissue injury remains a major factor in reoperation [11]. The SCARF classification contributes to initial management decisions [18], yet there are no consistent differences among treatment techniques for unstable dorsal fracture dislocations regarding range of motion, pain, or radiographic degeneration [20].

Management options range from minimally invasive closed reduction and percutaneous Kirschner wire pinning [25] to extension-block pinning, which provides stabilization and allows early movement [10, 24]. Percutaneous intramedullary reduction restores joint congruence for impacted volar fragments [13], while plate and screw constructs offer adequate stability for early active rehabilitation [12]. For volar injuries, dorsal blocking plates [22] and mini hook plates [23] have demonstrated satisfactory outcomes. Dynamic distraction external fixation is a significant advance for complex fractures, with results comparable to other techniques [3, 4], and remains effective even in delayed treatment scenarios [16]. Pins and rubber traction systems represent a safe, cost-effective modality [1], and routine palmar plate reinsertion may not be necessary in open dorsal dislocations [14].

Salvage procedures address severe or chronic injuries. Hemi-hamate reconstruction is a valuable option for severe fracture-dislocations [29], with long-term hamate osteochondral grafts generally providing acceptable clinical and radiologic outcomes [9]. However, hamate morphology differences may preclude anatomical reconstruction in dorsal injuries, affecting outcomes [5]. Bilateral hamates can serve as donor grafts for multiple unrepairable injuries [27]. Open reduction of chronic untreated dislocations can achieve functional range of motion with a stable joint [6], and PIP joint nonunion or malunion should be treated as soon as recognized to achieve excellent recovery with minor donor site sacrifice [30].

Anatomy & Pathophysiology

Fracture Patterns and Classification

PIP joint fracture dislocations are classified into three basic fracture patterns: palmar lip fractures, dorsal lip fractures, and pilon fractures [55]. Pilon fractures of the base of the middle phalanx are not truly fractures [26]. PIP joint dislocations are defined by the position of the middle phalanx in relation to the proximal phalanx and are classified as dorsal, lateral, or volar [58]. Dorsal dislocations represent almost all PIP joint dislocations [58]. Open dislocations are predominantly dorsal dislocations of the index and middle fingers [37].

Mechanisms of Injury

The mechanism for dorsal PIP dislocations involves forced hyperextension, axial load, and radial or ulnar deviation [58]. Lateral PIP dislocations result from direct radial or ulnar stress on the joint with axial load [58]. Volar PIP dislocations require force in two vectors: ulnar or radial deviation causing rupture of the collateral ligament and volar plate, combined with an anteriorly directed force [58]. A laterally directed force to the PIP joint results in avulsion of the collateral ligament from its proximal attachment on the side of the applied force [87]. Continued lateral force causes the volar plate to tear on the side of injury, resulting in lateral dislocation [87]. Complex volar dislocations involve rotary displacement with a collateral ligament tear secondary to lateral stress combined with an anteriorly directed force [87].

Soft Tissue Pathology

Dorsal PIP dislocations are characterized by volar plate rupture at its distal attachment [58]. These injuries involve a split between the accessory collateral ligament and proper collateral ligament with detachment of the proper collateral ligament from its proximal attachment [58]. In dorsal PIP dislocations, the volar plate is maintained beneath the condyle, held by intact attachment to the accessory collateral ligament [58]. When a torsional mechanism is involved in dorsal PIP dislocations, soft tissue interposition can block reduction [58]. In uncomplicated dorsal PIP fracture-dislocations with a fracture fragment consisting of more than 40% of the middle phalanx base, the central slip of the extensor mechanism ruptures or avulses from the dorsal lip of the middle phalanx [87]. Failure to immobilize the joint in extension to allow central slip healing can lead to stretching of the triangular ligament holding the lateral bands, resulting in their volar subluxation [87]. Subluxated lateral bands can no longer extend the PIP joint, and tightening of the terminal extensor slip leads to hyperextension of the distal interphalangeal joint, creating a boutonniere deformity [87]. In complicated volar dislocations, the central slip, lateral band, or torn collateral ligament may be interposed within the joint [87]. In irreducible volar dislocations caused by interposition of the intact central slip, the extensor mechanism is displaced rather than disrupted [96].

Joint Stability and Biomechanics

Proper treatment of PIP joint fracture dislocations is predicated on maintenance of concentric reduction of the joint, restoration of joint stability, and institution of early motion [55]. Anatomic reconstitution of the articular surface is less important than maintaining concentric reduction and stability [55]. Simulated volar articular bony defects of 20% were stable, whereas those with 60% and 80% defects were unstable during digital motion [88]. Percent articular involvement and relative fragment displacement are objective measurements that can help characterize joint stability and assist with decision-making [34]. Inappropriate treatment of PIP joint fracture dislocations can lead to a dysfunctional joint secondary to persistent pain, stiffness, and posttraumatic degenerative arthrosis [55]. Suboptimal treatment of intra-articular fractures typically leads to functional impairment of the hand [31]. Flexion contractures and stiffness are common in PIP joint fracture-dislocations, and obtaining full range of motion is rare [89]. Early motion is a key treatment element for success in PIP joint fracture-dislocations [89]. Restoration of stability allowing early motion and a smooth articular surface are the goals of treatment for dorsal PIP fracture-dislocations [94].

Chronic and Neglected Injuries

Chronic volar dislocations of the PIP joint are rare but present a therapeutic challenge when they occur [26]. If the duration between injury and treatment for a chronic volar dislocation is relatively short, the joint may still be supple and reducible without soft tissue releases [26]. If 2 months or more have elapsed between injury and treatment for a chronic volar dislocation, there is a significant likelihood that the deformity has become fixed and that collateral ligament and possibly volar plate releases may be needed [26]. The range of motion at follow-up for chronic PIP joint dislocations is likely to be significantly less than in those in whom the injury is treated acutely [26]. In one series of chronic PIP joint dislocations, range of motion averaged 70 degrees and the incidence of complications, including extension lag of the DIP joint, was high [26]. Open reduction of chronic untreated PIP joint dislocations can successfully achieve a functional range of motion with a stable joint [6].

Classification

PIP joint dislocations are classified as dorsal, lateral, or volar based on the position of the middle phalanx in relation to the proximal phalanx [58]. Dorsal dislocations may involve a torsional mechanism where soft tissue interposition blocks reduction [58]. Lateral dislocations are less common and result from direct radial or ulnar stress on the joint with axial load [58]. In these injuries, the collateral ligament on the side of the force fails under tension, avulsing from its proximal attachment, while continued force causes disruption of the volar plate on the same side [58]. Volar dislocation is the least common type and may occur with or without a rotatory component [58]. It requires force in two vectors, including ulnar or radial deviation causing rupture of the collateral ligament and volar plate [58].

Schenck: The Schenck classification categorizes PIP fracture dislocations by articular side involvement and the degree of dorsal dislocation [98]. Fracture grades are defined by surface involvement: grade I is less than 10%, grade II is 11%–20%, grade III is 21%–40%, and grade IV is greater than 40% [98]. Dorsal dislocation grades are defined by the extent of dislocation: grade A is less than 25%, grade B is 25%–50%, grade C is greater than 50%, and grade D is full dislocation [98].

SCARF: The SCARF classification contributes to the management of PIP dislocations at initial therapy [18]. Understanding the fracture within the context of a stability-based classification system helps guide the selection of the most appropriate treatment [55].

Other Considerations: Radiographic estimation of volar lip fragment size in PIP dorsal fracture-dislocations routinely underestimates the actual fragment size [97]. The mean difference between radiographic and digital measurements was −9% (95% CI −13.7 to −4.3), with a range of underestimation from −35% to 7% [97]. Intraclass correlation coefficients for radiographic measurement of volar lip fragment size ranged from 0.76 to 0.98, averaging 0.93 [97].

Clinical Presentation

Patients frequently misinterpret PIP joint injuries as "jammed fingers" that will heal spontaneously, an attitude that can result in chronic volar fracture dislocations [26]. Timely diagnosis is imperative, especially if there is any persistent incongruity of the joint, as PIP joint fracture dislocations may rapidly develop fixed deformity [15]. Persistent incongruity in PIP joint fracture dislocations can leave an athlete with a poor outlook for complete correction [15]. Early recognition of joint instability is essential for adequate treatment of injuries of the PIP joint [17].

Acute and subacute PIP joint injuries present with mild to moderate swelling about the joint [78]. Palmar fracture of the base of the middle phalanx may lead to a clinical deviation and rotational deformity of the digit [78]. Injury may be associated with fracture of the distal interphalangeal (DIP) joint resulting in a bony mallet deformity or a tendinous injury [78]. PIP joint subluxation on lateral radiographs presents a “V” sign [78].

Chronic volar dislocations of the PIP joint are rare and present a therapeutic challenge when they occur [26]. If the duration between injury and treatment is relatively short, the joint may still be supple and reducible without soft tissue releases [26]. In cases where 2 months or more have elapsed between injury and treatment, there is a significant likelihood that the deformity has become fixed [26]. Fixed deformities in chronic PIP joint injuries may require collateral ligament and possibly volar plate releases to mobilize the joint and the fracture fragment [26]. The range of motion at follow-up for chronic PIP joint injuries is likely to be significantly less than in those treated acutely [26]. In one series of chronic PIP joint injuries, range of motion averaged 70° and the incidence of complications, including extension lag of the DIP joint, was high [26].

Investigations

Other Considerations: Clinical outcomes for PIP joint dislocations and fracture-dislocations are frequently difficult to predict owing to the complexity of fracture patterns and the potential for sub-acute or chronic presentation [7]. Timely diagnosis is imperative, particularly when persistent joint incongruity is present, as these injuries may rapidly develop fixed deformity [15]. A careful physical examination is essential to direct care and determine if future testing is indicated [45]. Patients often struggle to accurately describe their symptoms and may incorrectly attribute pathology to a perceived deficit [45]. While diagnostic tests such as imaging and serum laboratory studies are useful in determining pathology, they can be expensive, time-consuming, and often nonspecific [45].

Treatment

General Principles

Timely diagnosis is imperative, particularly when persistent joint incongruity is present, as PIP joint fracture-dislocations may rapidly develop fixed deformity, leaving the patient with a poor outlook for complete correction [15]. Good function can be anticipated if early treatment is provided and articular surfaces are only partially damaged [51].

Non-Operative

Stable PIP joint fracture-dislocations can be managed nonsurgically [32]. For stable dorsal fracture-dislocations, buddy taping for several weeks allows early range of motion and has been shown to be superior to static immobilization [32]. In patients with stable volar fracture-dislocations, the extensor mechanism’s ability to heal must be considered [32]. Predictable restoration of central slip function can be achieved without surgery in fractures with an avulsed fragment displaced ≤2 mm [32]. Nonsurgical management of stable volar fracture-dislocations involves placing a splint dorsally, which immobilizes the PIP joint in full extension while allowing motion at the DIP and MCP joints [32]. The PIP joint remains immobilized for 3 to 4 weeks, after which a dynamic extension splint is used for another 2 weeks, allowing active flexion [32]. Surgery should be considered when the fracture displacement is large enough to raise concern regarding excessive extensor lag of the PIP joint [32]. Tenuous dorsal fracture-dislocations with no hinging during range of motion are often managed with extension block splinting, which prevents extension of the PIP joint into the range where it is unstable [32]. The literature demonstrated positive outcomes for fractures presenting with less than 30% joint involvement that were managed nonsurgically [38].

For athletes, players with stable injuries of the PIP joint, including most sprains of the collateral ligaments and simple reducible dislocations, can generally safely return to play with buddy taping to the adjacent digit to prevent hyperextension and recurrent lateral displacement [80]. Reducible volar lip fracture dislocations classified as stable can be treated with buddy taping, with little or no loss of playing time, although close observation with appropriate range-of-motion exercises improves the return of full motion [80]. Static stretch or dynamic splinting can also help prevent stiffness during nonpractice or playing times [80]. Nonstable injuries, including volar lip fractures, classified as tenuous require dorsal block splinting to maintain reduction of the joint [80]. Dorsal block splinting is of no benefit if recurrent subluxation is allowed during times of play [80]. The use of a bivalve finger fracture orthosis demonstrated an alternative approach to surgical treatment for PIP fracture dislocation injuries, proving successful in reducing challenges associated with the injury [42]. There were no cases of non-union or joint collapse in a case series examining traction management of PIP joint injuries [48].

Operative

Indications: For professional athletes with PIP joint fracture dislocations, open reduction internal fixation is favored, along with active range of motion within a few days and return to protective play between 5 and 8 weeks depending on the individual circumstance [36].

Surgical Approach / Technique: EBP offers a simple and innovative method to treat a complex injury of the PIP joint [41]. Under general anaesthesia, the central slip of the extensor tendon is identified and dissected distally to its attachment to the avulsed dorsal fragment at the base of the middle phalanx [77]. The fracture fragment is reduced and fixed using a single 1-mm mini-fragment cortical screw across the fracture plane, and the central slip is reconstituted [77]. The fixation is supplemented with external palmar splintage for 1 week, and physiotherapy is commenced thereafter [77]. Passive or active motion of the distal IP and PIP joints is encouraged to prevent joint stiffness [77].

Implant Selection: Potential disadvantages of mini-fragment screw fixation include interference with flexor digitorum profundus and reduced DIP joint movement as the tendon may be caught in the distal thread of the screw [77]. Interference with flexor digitorum profundus can be prevented if fluoroscopic screening is used after fixation and passive DIP joint exercises are employed [77]. Prominence of the screw dorsally requiring removal of the screw as a second procedure is a potential disadvantage of mini-fragment screw fixation [77].

External Fixation and Traction: External fixation represents a safe, efficient, and cost-effective treatment modality for fractures involving the PIP joint [1]. Results are comparable with other techniques used in the management of unstable PIP joint fracture-dislocations [3]. This seems a significant advance in treatment of complex PIP joint fractures and may be of use in other types of IP joint injury [4]. Delayed treatment of unstable PIPJ fracture-dislocations with a DDEF is effective in restoring function to the PIPJ [16]. Average PIPJ-ROM was 76.4 ± 23.51°, and the average grip-strength was 85 ± 13.95% as compared to the healthy side [40]. All 3 external fixators restored PIP joint stability following simulated dorsal fracture-dislocation, with all reductions maintained after motion testing [43]. The 3DPDEF is a suitable option for PIP fracture-dislocations, providing stability comparable to that of the PRTS while offering benefits, such as easy placement, controlled distraction, and clear visualization of the articular surface [56]. The Ligamentotaxor is a safe and effective device for managing intra-articular PIPJ injuries, offering practical advantages and comparable efficacy to other devices [79].

Chronic, Neglected, or Complex Cases: The differences may still preclude anatomical reconstruction in the setting of a dorsal PIP fracture-dislocation, thereby affecting short- and long-term outcomes [5].

Radiological and Functional Outcomes: Follow-up radiographs showed bone healing in all cases [21]. At the time of final follow-up, 20 patients (95%) showed a stable aligned and centered joint [21]. Twelve patients achieved bone union in anatomic alignment, whereas seven patients showed a central articular step off of mean 0.3 mm (SD 0.1 mm) [21]. One patient showed a deepened articular cavity of 1.2 mm [21]. One patient remained in a subluxated dorsal position and showed a restricted movement with stage 4 osteoarthritis following a pin infection [21]. 85.7% of patients had minimal-to-severe osteoarthritic changes [21]. Three patients showed osteoarthritis stage 0, five stage 1, nine stage 2, three stage 3, and one stage 4 [21].

Complications

Infection and Pin-Related Complications: Superficial pin track infection occurred in 5 of 53 patients (55 injured fingers) treated with extension block pinning, with a mean onset of 13 days (range 7–17 days) post-operation [39]. All superficial pin track infections following extension block pinning were successfully treated with local pin site care and a short course of oral antibiotics [39]. In a separate series treated with a parabolic dynamic external fixator, one patient developed stage 4 osteoarthritis following a pin infection [21].

Joint Stiffness, Arthritis, and Functional Impairment: Osteoarthritic changes are a frequent long-term sequela. In a series of 20 patients treated with a parabolic dynamic external fixator for pilonoidal fracture dislocations, 85.7% had minimal-to-severe osteoarthritic changes at final follow-up [21]. Specifically, 3 patients had stage 0, 5 had stage 1, 9 had stage 2, and 3 had stage 3 osteoarthritis [21]. One patient in this series remained in a subluxated dorsal position with restricted movement [21]. Following extension block pinning, joint stiffness was the primary reason for dissatisfaction in five fingers, poor grip posture in three fingers, and pain in one finger among patients followed long-term [39]. Fracture dislocations of the PIP joint may rapidly develop fixed deformity if diagnosis is not timely, leaving a poor outlook for complete correction [15]. In a series of chronic volar PIP joint dislocations, range of motion averaged 70 degrees, with a high incidence of complications including extension lag of the DIP joint [26].

Reoperation and Salvage Procedures: Salvage procedures are occasionally required for persistent symptoms or instability. Two patients underwent PIP arthrodesis for persisting pain at 5 and 10 months after injury following extension block pinning [39]. One patient with an associated distal phalangeal shaft fracture underwent distal interphalangeal (DIP) arthrodesis 2 years after the initial injury following extension block pinning [39]. One patient sustained another dorsal fracture-dislocation of the same PIP joint 8 years after the first injury, which was treated by extension block pinning [39]. In a series of central slip fracture subluxations/dislocations, six of 8 patients had radiographic evidence of arthritis prior to salvage procedures or at follow-up [91]. At the time of K-wire or external fixator removal, the PIP joint was subluxated in 3 patients and dislocated in 1 patient [91]. At follow-up, the PIP joint was subluxated in 2 of the 5 patients who did not undergo salvage procedures [91].

Malunion and Nonunion: Radiographic malunion is observed in a subset of patients treated with external fixation. In a series treated with a parabolic dynamic external fixator, twelve patients achieved bone union in anatomic alignment, whereas seven patients showed a central articular step off [21]. One patient showed a central articular step off of mean 0.3 mm (SD 0.1 mm) at final follow-up [21]. One patient showed a deepened articular cavity of 1.2 mm at final follow-up [21]. Intraoperative fractures occur in about 5% of PIP joint arthroplasties and do not appear to influence outcomes, including revision surgery, refracture rate, or other early complications [83].

Chronic and Delayed Presentation Complications: If 2 months or more have elapsed between injury and treatment for a chronic volar PIP joint dislocation, there is a significant likelihood that the deformity has become fixed and that collateral ligament and possibly volar plate releases may be needed [26].

Recovery

Rehabilitation protocol: Early active motion following dorsolateral dislocation of the PIP joint yields significantly superior results in active range of motion and pinch power compared with static splinting [104]. Specific devices facilitate early active joint movement while providing lateral stability without rotation or angular deformity [53].

Other Considerations: Long-term functional outcomes vary by procedure and injury severity. Short-term results for hamate osteochondral grafts are encouraging, with patients returning to pre-injury work and reporting low pain scores [44]. HHA reconstruction demonstrates promising early functional outcomes for delayed, severe dorsal PIPJ fracture-dislocations [33]. Volar transverse plating allows for highly functional range of motion without clinical PIP dorsal subluxation in cases involving comminution and delayed presentation [35].

A review of medical records for the original 53 patients with 55 injured fingers identified further sequels in eight patients [39]. Five patients, three of whom were included in the follow-up cohort, experienced superficial pin track infections between 7–17 days (mean 13) post-operation [39]. All infections were successfully managed with local pin site care and a short course of oral antibiotics [39]. Two patients, one of whom had an early postoperative superficial infection and was included in the follow-up cohort, underwent PIP arthrodesis for persisting pain at 5 and 10 months after injury [39]. One patient in the follow-up cohort with an associated distal phalangeal shaft fracture underwent distal interphalangeal (DIP) arthrodesis two years after the initial injury [39]. Another patient in the follow-up cohort sustained a recurrent dorsal fracture-dislocation of the same PIP joint, treated by extension block pinning eight years after the first injury [39].

The follow-up cohort comprised 31 patients (mean age 56 years; range 33–84) with 33 injured fingers, studied after a mean follow-up of 16 years (SD 3; range 12–21) [39]. Five patients, including the one treated by PIP arthrodesis, were interviewed remotely and thus lack objective outcomes [39]. Present function of the injured finger was subjectively satisfactory in 24 of 33 cases at final follow-up [39]. The patient who underwent PIP joint arthrodesis was satisfied with the present function of the finger [39]. The primary reasons for dissatisfaction were joint stiffness (five fingers), poor grip posture (three), or pain (one) [39]. One of the patients dissatisfied due to stiffness had undergone DIP arthrodesis [39].

Key Evidence

  • [L4] It represents a safe, efficient, and cost-effective treatment modality for fractures involving the PIP joint. [1] (10.1007/s00402-007-0526-1)
  • [L5] This article serves as a reference for the current understanding and best practices in treating PIP joint fracture dislocations, emphasizing that treatment is based on joint stability, fracture fragment size, and soft tissue injuries. [2] (10.1016/j.hcl.2017.12.005)
  • [L4] Our results are comparable with other techniques used in the management of unstable PIP joint fracture-dislocations. [3] (10.1016/j.jhsa.2007.07.018)
  • [L4] This seems a significant advance in treatment of complex PIP joint fractures and may be of use in other types of IP joint injury. [4] (10.1016/s0020-1383(98)00034-5)
  • [L4] The differences may still preclude anatomical reconstruction in the setting of a dorsal PIP fracture-dislocation, thereby affecting short- and long-term outcomes. [5] (10.1016/j.jhsa.2019.11.009)
  • [L4] This surgical technique of open reduction of chronic untreated PIP joint dislocations can successfully achieve a functional range of motion with a stable joint. [6] (10.1016/j.jhsa.2020.07.002)
  • [L5] Clinical results for PIP joint dislocations and fracture-dislocations vary and are often difficult to predict due to the complexity of fracture patterns and potential for sub-acute or chronic presentation. [7] (10.1177/17531934231183259)
  • [L4] For DIP joint fractures, 50% of cases had only fair or poor results, whereas PIP joint fractures generally yielded satisfactory outcomes. [8] (10.1054/jhsb.1999.0228)
  • [L4] The long-term results of hamate osteochondral grafts for PIP fracture-dislocation have generally acceptable clinical and radiologic outcomes. [9] (10.1016/j.jhsa.2025.11.020)
  • [L4] The extension block pinning technique is a simple and valuable technique for treating unstable dorsal PIP fracture-dislocation injuries producing satisfactory long-term results. [10] (10.1016/j.jhsa.2015.11.007)
  • [L3] Soft tissue injury is a major factor in reoperation after PIP joint fracture dislocation. [11] (10.1177/1558944719858429)
  • [Case_report] The plate and screw construct provides adequate stability for dorsal fracture-dislocations of the PIP joint to allow early active rehabilitation, potentially resulting in better functional outcomes compared to screws alone. [12] (10.1016/j.jhsa.2010.02.011)
  • [L4] Percutaneous, intramedullary reduction of the impacted volar articular fragments associated with unstable, dorsal fracture–dislocation of the PIP joint restores joint congruence and function. [13] (10.1016/j.jhsa.2010.08.004)
  • [L4] These findings suggest that routine palmar plate reinsertion may not be necessary in open dorsal PIPJ dislocations. [14] (10.1177/17531934261464365)
  • [L5] Timely diagnosis is imperative, especially if there is any persistent incongruity of the joint, as fracture dislocations of the PIP joint may rapidly develop fixed deformity, leaving an athlete with a poor outlook for complete correction. [15] (10.1016/j.hcl.2012.05.036)
  • [Paper] Delayed treatment of unstable PIPJ fracture-dislocations with a DDEF is effective in restoring function to the PIPJ. [16] (10.1016/j.injury.2015.06.027)
  • [L5] Early recognition of joint instability is essential for adequate treatment of injuries of the PIP joint. [17] (10.5435/00124635-200011000-00006)
  • [L2] The SCARF classification would contribute to management of PIP dislocations at the initial therapy. [18] (10.1016/j.jos.2019.08.007)
  • [L5] There are no consistent differences among treatment techniques for unstable dorsal fracture dislocations of the PIP joint regarding range of motion, pain, or radiographic degeneration. [20] (10.1016/j.jhsa.2008.08.017)
  • [Paper] [21] (10.1007/s00402-019-03275-8)
  • [L4] A dorsal blocking plate is a simple technique, associated with a satisfactory outcome, for volar fracture dislocation injuries of the PIP joint. [22] (10.1016/j.jhsa.2021.07.025)
  • [L4] The technique using a mini hook plate achieved rigid fixation and early active motion in a patient with a chronic palmar PIP joint fracture-dislocation, resulting in a successful outcome with almost normal ROMs. [23] (10.1007/s00402-010-1200-6)
  • [L4] Extension-block pinning is a simple and reproducible technique that provides stabilization and allows early movement of the PIP joint, yielding highly satisfactory functional results for dorsal fracture-dislocation of the PIP. [24] (10.1016/j.otsr.2012.02.009)
  • [L4] Closed reduction and percutaneous Kirschner wire pinning in dorsal fracture-dislocations of the PIP joint is a minimally invasive and simple technique which appears to give satisfactory outcomes in the short to intermediate term. [25] (10.1007/s11552-014-9660-8)
  • [L5] [26] (10.1016/s0749-0712(21)00575-8)
  • [Case_report] It is the first reported case of using bilateral hamates as donor grafts for two PIP joint fracture dislocations, suggesting this approach can restore normal function in patients with multiple unrepairable injuries. [27] (10.1016/j.jhsg.2024.07.001)
  • [L4] Hemi-hamate reconstruction represents a valuable surgical procedure to address severe PIP joint fracture–dislocations. [29] (10.1016/j.jhsa.2009.04.027)
  • [L4] Treat PIP joint nonunion and malunion as soon as it is recognized, excellent recovery can be achieved with minor donor site sacrifice. [30] (10.1016/j.jhsa.2015.06.043)
  • [L5] Suboptimal treatment of intra-articular fractures typically leads to functional impairment of the hand. [31] (10.1177/1753193414559464)
  • [L5] [32] (10.5435/jaaos-21-02-88)
  • [L5] In this small case series, HHA reconstruction showed promising early functional outcomes for delayed, severe dorsal PIPJ fracture-dislocations. [33] (10.1016/j.jhsg.2026.101061)
  • [L3] Percent articular involvement and relative fragment displacement are objective measurements that can help characterize joint stability and assist with decision-making. [34] (10.1177/1558944719895621)
  • [L4] This volar transverse plating technique allows for highly functional range of motion without PIP dorsal subluxation clinically in the setting of comminution and delayed presentation. [35] (10.1177/1558944718790063)
  • [L5] For professional athletes with PIP joint fracture dislocations, the author favors open reduction internal fixation, active range of motion within a few days, and return to protective play between 5 and 8 weeks depending on the individual circumstance. [36] (10.1016/j.hcl.2012.05.038)
  • [L4] Open dislocations are predominantly dorsal dislocations of the index and middle fingers. [37] (10.1177/17531934251405707)
  • [L4] The literature demonstrated positive outcomes for fractures presenting with less than 30% joint involvement that were managed nonsurgically. [38] (10.1177/15589447241231308)
  • [L4] [39] (10.1177/17531934221102251)
  • [L4] Average PIPJ-ROM was 76.4 ± 23.51°, and the average grip-strength was 85 ± 13.95% as compared to the healthy side. [40] (10.1007/s00068-020-01443-9)
  • [L4] EBP offers a simple and innovative method to treat a complex injury of the PIP joint. [41] (10.1177/15589447211066352)
  • [L4] The use of a bivalve finger fracture orthosis demonstrated an alternative approach to surgical treatment for PIP fracture dislocation injuries in this patient, proving successful in reducing challenges associated with the injury. [42] (10.1016/j.jht.2014.08.002)
  • [L5] All 3 external fixators restored PIP joint stability following simulated dorsal fracture-dislocation, with all reductions maintained after motion testing. [43] (10.1016/j.jhsa.2022.01.019)
  • [L4] The short-term results of hamate osteochondral grafts for PIP fracture-dislocation are encouraging, with patients returning to pre-injury work and low pain scores. [44] (10.1177/1753193416671886)
  • [L4] [48] (10.1177/1758998313490856)
  • [L4] The device allows early active joint movement and provides good lateral stability without rotation or angular deformity. [53] (10.1177/0300060519826821)
  • [L5] [55] (10.1053/jssh.2002.33317)
  • [L5] The 3DPDEF is a suitable option for PIP fracture-dislocations, providing stability comparable to that of the PRTS while offering benefits, such as easy placement, controlled distraction, and clear visualization of the articular surface. [56] (10.1016/j.jhsa.2024.09.019)
  • [L5] [58] (10.1016/j.hcl.2017.12.004)
  • [L4] [77] (10.1007/s004020000156)
  • [Paper] [78] (10.4103/0970-0358.90822)
  • [L4] The Ligamentotaxor is a safe and effective device for managing intra-articular PIPJ injuries, offering practical advantages and comparable efficacy to other devices. [79] (10.1177/1753193415578305)
  • [L5] [80] (10.1016/j.hcl.2012.05.039)
  • [L3] Intraoperative fractures occur in about 5% of PIP joint arthroplasties and do not appear to influence outcomes, including revision surgery, refracture rate, or other early complications. [83] (10.1016/j.jhsa.2015.06.101)
  • [L5] [87] (10.1016/j.hcl.2009.05.008)
  • [L5] Simulated volar articular bony defects of 20% were stable, whereas those with 60% and 80% defects were unstable during digital motion. [88] (10.1016/j.jhsa.2013.09.025)
  • [L4] Flexion contractures and stiffness are common, and obtaining full range of motion is rare, making early motion a key treatment element for success. [89] (10.2106/jbjs.rvw.o.00019)
  • [L4] [91] (10.1016/j.jhsa.2017.03.030)
  • [L5] Restoration of stability allowing early motion and a smooth articular surface are the goals of treatment. [94] (10.1016/j.jhsa.2015.08.023)
  • [L4] The prognosis is far better after irreducible than after reducible volar dislocations because the extensor mechanism is displaced, not disrupted. [96] (10.2106/00004623-197860010-00023)
  • [L4] [97] (10.1177/1558944718777831)
  • [Paper] [98] (10.4055/cios.2019.11.2.220)
  • [L3] Early active motion after dorsolateral dislocation of the PIP joint produces significantly superior results regarding the active range of motion and pinch power than static splinting. [104] (10.1007/s00402-004-0707-0)

See Also

References

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