Review Question - QID 6415

The patient sustained a dorsal fracture-dislocation of the PIP joint. This is a very common injury and treatment options are variable. When there is no fracture of the base of the middle phalanx, extension block splinting is the best option. When a fracture is present, the stability of the fracture and the proportion of the base of the middle phalanx that is involved must be evaluated. If the fracture surface is less than 25% of the base and the joint reduces adequately in flexion, then extension block splinting is the best treatment option. When more than 25% of the joint is involved and/or the joint does not reduce completely in flexion, then surgical treatment is indicated. Dynamic external fixation is an effective and less invasive option for moderate injuries. Open repair or volar plate arthroplasty is typically reserved for severe injuries of more than 50% of the joint surface. In this patient, less than 25% of the joint surface is involved. The postreduction radiographs show an excellent congruent reduction. Because the PIP joint redislocates only in full extension, a PIP joint extension block splint should be applied (40-degree block) and the patient should be allowed to flex the finger. Over the next 3 weeks, the extension block can be reduced 10 degrees per week.