Management of PIP Dislocation with Avulsion Fracture

Assessment and Classification

• PIP joint dislocations with avulsion fractures should be evaluated for stability, displacement, and joint congruity to determine the optimal treatment approach, with unstable injuries with significant displacement (>3mm), dorsal tilt (>10°), or substantial intraarticular involvement requiring more rigid immobilization or surgical intervention 1

Treatment Recommendations

• Rigid immobilization with splinting is preferred for unstable injuries with significant displacement 1
• Do not attempt to straighten or realign an angulated fracture-dislocation in the first aid setting, as this may cause further injury, and splint in the position found if immediate medical care is not available 2

Rehabilitation Considerations

• Active finger motion exercises should be performed as soon as stability allows to prevent stiffness, which is one of the most functionally disabling adverse effects, and finger stiffness can be very difficult to treat after healing, potentially requiring multiple therapy visits and additional surgical intervention 3

Potential Complications and Pitfalls

• Prolonged rigid immobilization beyond what is necessary can lead to joint stiffness and decreased function 3
• Inadequate stabilization of unstable injuries can result in malunion, joint incongruity, and subsequent arthritis 1

Follow-up Recommendations

• Regular radiographic follow-up is recommended at approximately 3 weeks and at the time of immobilization removal to confirm adequate healing 4
• If pain persists or range of motion deteriorates, reevaluation is warranted to rule out complications 5