Treatment of Intraarticular Fractures at the PIP Joint
Assessment and Classification
- Intraarticular fractures with displacement require careful evaluation of the degree of displacement, joint congruity, and stability to determine the optimal treatment approach 1
- Fractures are classified as significantly displaced when there is >3mm displacement or >10° dorsal tilt 1
- The presence of intraarticular extension is a critical factor that influences treatment decisions, as it can lead to joint incongruity and subsequent arthritis if not properly addressed 2
Treatment Options
- Conservative management is not typically recommended for intraarticular fractures with displacement due to risk of joint incongruity and subsequent arthritis 1
- Removable splints may be appropriate only for minimally displaced fractures without significant intraarticular involvement 4
- Dynamic External Fixation is effective for unstable intraarticular fractures 2
- Arthroscopic-Assisted Reduction is an option for improved diagnostic accuracy and treatment of intraarticular fractures, and allows for evaluation and treatment of associated ligament injuries 2, 3
Post-Operative Management
- Active finger motion exercises should be initiated as soon as stability allows to prevent stiffness 1, 4
- Radiographic follow-up is recommended at approximately 3 weeks and at the time of immobilization removal to confirm adequate healing 4