PIP JOINT 2
accomplished with the MCP and PIP fully flexed (to relax the lateral bands) then traction. Once reduced, early active motion is instituted with buddy taping.
Dorsal PIP Fracture Dislocation
This is the worst of all PIP dislocations, probably because the treatment generally requires some degree of immobilization in flexion.
The critical thing to determine is how much of the articular surface of the middle phalangeal base has been fractured off – this, of course, underestimates the chondral injury.
Treatment – Acute Injuries
Controversial – some advocate closed treatment, other advocate surgery.
If closed reduction is successful, the PIP is held in a dorsal extension block splint in about 60o of flexion, and each week is allowed to extend 10-15 more degrees. Ie – initially, the reduction often needs to be held in a fair amount of flexion (bad!), and this is gradually released over the course of 4-6 weeks. Active flexion is allowed throughout.
If closed reduction is unsuccessful, or if the volar lip fragment is big (at least 30%), open reduction is carried out. It is not clear from the text if they would immediately go after a big fragment, or if they would reduce it closed and see what the quality of the reduction were like….
Treatment – Chronic Injuries
Closed reduction is unlikely to be possible beyond 1-2 weeks.
The authors of Rockwood and Green favor Eaton’s volar plate arthroplasty.