Fractures and Dislocations of the Proximal Interphalangeal Joint

Abstract

The proximal interphalangeal joint (PIPJ) is commonly injured. Many of these injuries are relatively minor, but the joint is unforgiving and frequently becomes stiff. Early appropriate treatment will minimalize long-term problems and facilitate earlier safe return to sport. This chapter covers the essential anatomy and behaviour of these joints, common injury patterns and treatment as well as the rationale and pitfalls in management.

Questions and Answers

• 1. What radiographs should be requested following a dislocation of the PIP joint?

• 2. After reduction of a dislocation, there remains slight incongruency of the joint. What does this herald?

• 3. What deformity of the finger may develop after an untreated injury to the central slip of the extensor tendon?

• 4. Which finger is most susceptible to avulsion flake fractures from the palmer lip of the middle phalanx? What is the treatment?

• 5. Why do most condylar fractures require operative stabilization?

Answers

• A 1. PA and true lateral views of the joint.

• A 2. Soft tissue interposition of the joint. Often the collateral ligament will be ruptured and the condyle on that side will be protruding through a rent in the extensor mechanism mandating exploration.

• A 3. “Boutonniere” deformity. These are significant injuries to the PIPJ. The results of treatment, even when timely and appropriate, are often disappointing.

• A 4. The middle finger, particularly in netball and basketball players. Mobilization of the digit and return to sport with “buddy taping” after 1–2 weeks.

• A 5. Condylar fractures have an unstable fracture pattern. If they heal in a displaced position, this results in joint incongruity and deformity of the finger. A single lag screw inserted through a lateral approach yields good results.