What are treatment options for dorsal PIP joint dislocations?

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

A dorsal PIP joint dislocation is reduced easily with traction on the finger, followed with flexion of the PIP joint. After reduction, joint stability is provided by the intact collateral ligaments. As long as the reduction is stable, the joint congruent, and the fragment, if present, is small and minimally displaced, a dorsal extension block splint is used. Large displaced fragments lead to joint instability and respond best to operative treatment. However, some comminuted fractures can be treated only by traction and early range of motion. No treatment is likely to provide complete pain-free range of motion in these injuries.

The PIP joint should be immobilized in approximately 30° of flexion for 2-3 weeks. Buddy taping or other protective splinting should be used for another 3-4 weeks during activity or sports participation. The most important principle is the prevention of hyperextension, which could reinjure the volar plate.

If the dorsal PIP joint dislocation cannot be reduced because the proximal phalangeal head is impinged between the central slip and the lateral bands, then open reduction is required. Otherwise, these injuries can be treated with buddy taping, which is worn continuously for the first 3 weeks and then only during physical activities for an additional 4-6 weeks. Complete resolution of pain usually takes 4-6 months, although a slight residual swelling is often permanent.

Grade I and II injuries are treated with extension block splints, which limit the last 20-30° of extension but allow full flexion of the distal joint. Active protected extension is begun at 2 weeks, and athletes can be allowed to play with buddy taping. Protection should be continued for 6-8 weeks or until joint motion is pain free.

Grade III injuries, which includes irreducible dislocations, usually require surgery. If left undertreated, grade III injures can lead to permanent deformity, lost motion, and degenerative joint changes. Radiographs should be taken in the AP, lateral, and oblique planes.


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