Management of Proximal Interphalangeal Joint Injuries
Section snippets
Anatomy and biomechanics
The PIP joint is a hinged joint capable of flexion and extension, the simplicity of which belies the anatomic and functional complexity of this joint. The proximal surface of the PIP joint consists of a double condyle configuration, with the base of the middle phalanx providing the complementary negative image. The supporting ligaments and tendons provide the bulk of the static and dynamic stability of this joint as it travels through a normal range of 110 degrees [2], [3], [4], [5]. The
Diagnosis
An accurate anatomic diagnosis and a rational treatment plan require a full history, careful physical examination, and appropriate radiographic assessment. The patient's age, occupation, handedness, type of finger (long and slender vs. short and stubby), hobbies, and history of previous hand deformity are all relevant. It is necessary to elicit a description of the actual mechanism of the presenting injury to ascertain the direction and magnitude of the causative forces involved.
Physical
General treatment principles
As with other hand injuries, management must include considerations of such general treatment principles as elevation of the injured part, appropriate range of motion, analgesia and tetanus and antibiotic prophylaxis (where appropriate).
An injury involving open communication between the joint and a superficial laceration is contaminated and at significant risk of developing serious sequelae [7]. In these cases, formal lavage with meticulous debridement of the soft tissues is mandatory [8], with
Classification and management
Injuries about the PIP joint can be broadly classified into dislocations, avulsions, and intra-articular fractures (Table 1). After a careful clinical and radiographic assessment, a more detailed classification of the injuries forms the basis of the subsequent management.
Summary
Injuries about the PIP joint of the finger are commonly encountered by primary care physicians and are associated with significant morbidity, including pain, stiffness, instability, premature degenerative arthritis, and residual deformities. An accurate understanding of the regional anatomy and appreciation of the mechanism of injury allows for classification so that a treatment protocol can be formulated for each injury pattern. Emphasis on careful consideration of the implications of open
Acknowledgment
We thank Dr. Jeff Fialkov for the artistic diagram drawings.
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Cited by (40)
Proximal Interphalangeal Joint Dislocations
2022, Skeletal Trauma of the Upper ExtremityCommon Upper-Extremity Injuries
2020, Primary Care - Clinics in Office PracticeCitation Excerpt :All of these cases need physical/occupational therapy when healed. In patients with PIP joint injuries, the PIP joint should be thought of as a hinge joint that is kept in alignment by a soft tissue “envelope” that consists of the joint capsule, the volar plate, collateral ligaments, and the central slip.39 If a dislocation occurs, at least 2 of these structures are injured.
Injuries Around the Proximal Interphalangeal Joint
2019, Clinics in Plastic SurgeryCitation Excerpt :Repair of ruptured collateral ligaments with microsuture anchors is beneficial for early ROM, whereas volar plate avulsions are treated more commonly with extension block splinting or buddy taping. Repair of the central slip should be performed routinely to prevent boutonniere deformity.26,27,38 Stable PIPJ injuries are commonly treated nonsurgically, with extension block splinting or buddy taping.
Fracture-dislocation of the proximal interphalangeal joint of the long fingers: Report of an unusual case requiring open surgery
2018, Hand Surgery and RehabilitationFinger Fractures
2017, Fracture Management for Primary Care Updated Edition
This article is from: Freiberg A, Pollard BA, Macdonald MR, Duncan MJ. Management of proximal interphalangeal joint injuries. The Journal of Trauma: Injury, Infection, and Critical Care 1999;46(3):523–8; with permission from Lippincott Williams and Wilkins (www.lww.com).
All correspondence should be directed to: Alan E. Freeland, MD, Department of Orthopaedic Surgery & Rehabilitation, University of Mississippi Medical Center, 2500 N. State Street, MT 6th Floor, Jackson, MS 39216-4505, USA. E-mail address: [email protected].