What is the role of surgery for PIP joint fractures?

Updated: Jan 18, 2018
  • Author: Jay E Bowen, DO; Chief Editor: Craig C Young, MD  more...
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Answer

A comminuted fracture of the base involving the PIP joint can be difficult to treat. In these cases, traction with a transverse K-wire through the middle or distal phalanx can be used. They are removed after 6 weeks, but external splint immobilization is needed for an additional 2-4 weeks.

An alternative method, as described by Eaton, is primary volar plate arthroplasty in which the comminuted volar portion of the middle phalanx is removed and the volar plate is advanced into the defect.

For PIP fracture-dislocations, if a congruent reduction cannot be maintained or if more than 30-50% of the articular surface is involved, then arthroplasty may be required. If there is a large volar fragment, then internal fixation may be necessary. It is believed that fragments with greater than 2 mm of displacement lead to excessive extensor deficit and, therefore, warrant open reduction and internal fixation.

Successful surgical treatment of PIP fracture-dislocations is dependent on the following principles. The first is to reestablish the normal flexion glide of the middle phalanx around the proximal phalanx head during the flexion arc. Hinging at the fracture site must be avoided. The surgeon must eliminate joint subluxation and then reestablish joint stability. Second, early motion is initiated whenever possible to enhance cartilage and soft-tissue healing and also to minimize adhesions or contractures. Anatomic restoration of the fractured joint surface is desirable but is a much less important treatment goal.


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