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PIP Joint Fracture-Dislocation

68 citationsUpdated Oct 2026
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For patients: a plain-language version of this topic is available. See the patient guide.

Overview

Prognosis for PIP joint dislocations and fracture-dislocations is variable and often difficult to predict, driven by complex fracture patterns and the potential for sub-acute or chronic presentation [4]. Treatment decisions are fundamentally based on joint stability, fracture fragment size, and associated soft tissue injuries [5]. While PIP joint fractures generally yield satisfactory outcomes, 50% of DIP joint fracture cases result in only fair or poor results [6].

Soft tissue injury remains a major factor in reoperation following PIP joint fracture dislocation [19]. Anatomical reconstruction may be precluded by differences in hamate morphology in the setting of a dorsal PIP fracture-dislocation, thereby affecting short- and long-term outcomes [2]. Regarding unstable dorsal fracture dislocations, there are no consistent differences among treatment techniques concerning range of motion, pain, or radiographic degeneration [25].

Anatomy & Pathophysiology

Bony Anatomy and Joint Mechanics

The hand skeleton comprises 27 bones, 19 of which are long bones [47]. It is organized into five rays, each forming a polyarticulated chain of metacarpals and phalanges [47]. The proximal and middle phalanges of the middle and ring fingers are longer than those of the index finger [47]. Epiphyseal plates are located at the proximal ends of the phalanges [47]. The metacarpophalangeal (MCP) joints serve as the keystones of the longitudinal arches of the hand [64]. Their stability is essential to the support of both the longitudinal and transverse metacarpal arches [64]. The position of each articulation depends on the equilibrium of forces acting at that level and the position of the immediately proximal articulation [69]. Consequently, the wrist influences the position of the MCP joint, which in turn affects the position of the proximal interphalangeal (PIP) joint [69]. Almost all movements in the hand occur around oblique and variable axes, resulting in combined movements [69].

Soft Tissue Anatomy

Control of digital posture requires a complex balance of extrinsic and intrinsic muscle forces [46]. The principal bony insertion of the extrinsic digital extensors is on the dorsal proximal aspect of the middle phalanx [46]. MCP joint extension is provided by extrinsic extensor force transmitted through the sagittal bands [46]. These bands form a sling that allows proximal extrinsic extensor tension to be transmitted to the proximal phalanx [46]. The sagittal band fibers insert onto the volar proximal phalanx and onto the lateral borders of the volar plate [46]. Rupture or attenuation of the sagittal band fibers allows the extrinsic extensor tendon to sublux to the ulnar side of the metacarpal head [46]. Distal interphalangeal (DIP) joint extension is achieved through conjoined lateral bands composed of tendinous slips from extrinsic and intrinsic tendons [46]. The deep head of each dorsal interosseous muscle forms a lateral tendon, or lateral band, at the level of the MCP joint [61]. Oblique fibers from the lateral bands insert onto the lateral tubercles at the base of the middle phalanx to extend the PIP joint [61]. The flexor digitorum superficialis (FDS) tendon inserts via radial and ulnar slips into the proximal metaphysis of the middle phalanx [68]. The primary function of the FDS is digital flexion at the PIP joint [68]. The A3 annular pulley is located over the PIP joint [68]. The dorsal skin of the hand slides distally to allow MCP joint flexion [69]. Flexion of the PIP joint may occur at the expense of the segment of loose skin immediately above the joint [70].

Injury Mechanisms and Pathophysiology

PIP joint dislocations are classified as dorsal, lateral, or volar based on the position of the middle phalanx in relation to the proximal phalanx [58]. Dorsal dislocations represent almost all PIP joint dislocations [58]. The mechanism involves forced hyperextension, axial load, and radial or ulnar deviation [58]. This injury is characterized by volar plate rupture at its distal attachment [58]. It also involves a split between the accessory collateral ligament and proper collateral ligament, with detachment of the proper collateral ligament from its proximal attachment [58]. In this configuration, the volar plate is maintained beneath the condyle, held by intact attachment to the accessory collateral ligament [58]. Soft tissue interposition can block reduction when a torsional mechanism is involved [58]. Lateral dislocations are less common and result from direct radial or ulnar stress on the PIP joint with axial load [58]. The collateral ligament on the side of the force fails under tension, avulsing from its proximal attachment [58]. Continued force causes disruption of the volar plate on the side of the force [58]. Volar dislocations are rare and usually arise from a rotatory longitudinal force on a semiflexed digit [18]. This injury requires force in two vectors: ulnar or radial deviation causing rupture of the collateral ligament and volar plate, combined with an anteriorly directed force [58]. The anatomic disruption includes unilateral rupture of a collateral ligament and partial avulsion of the volar plate [18]. Volar dislocation is accompanied by herniation of the head of the proximal phalanx through the extensor mechanism [18]. An in-substance rupture of the central slip may be associated with this injury [18]. The most severe form involves a dorsal lip fracture of the base of the middle phalanx at the insertion of the central slip [18]. The severity of bone and soft tissue damage manifests in the degree of subluxation, size of the associated fracture, and pattern of displacement of fracture fragments [18].

PIP joint fracture dislocations are classified into three types based on the fracture geometry of the base of the middle phalanx: palmar lip fractures, dorsal lip fractures, and pilon fractures [54]. Open dislocations are predominantly dorsal dislocations of the index and middle fingers [41]. A laterally directed force to the PIP joint results in avulsion of the collateral ligament from its proximal attachment on the side of the applied force [92]. With continued force in lateral dislocation, the volar plate eventually tears on the side of injury, resulting in lateral dislocation [92]. In uncomplicated dorsal PIP fracture-dislocations, the central slip of the extensor mechanism ruptures or avulses from the dorsal lip of the middle phalanx [92]. Failure to immobilize the joint in extension to allow central slip healing can lead to stretching of the triangular ligament holding the lateral bands [92]. Stretching of the triangular ligament results in volar subluxation of the lateral bands, which can no longer extend the PIP joint [92]. Tightening of the terminal extensor slip following lateral band subluxation leads to hyperextension of the DIP joint, known as boutonniere deformity [92]. Complex volar dislocations involve rotary displacement with a collateral ligament tear secondary to lateral stress combined with an anteriorly directed force [92]. In complicated volar dislocations, the central slip, lateral band, or torn collateral ligament may be interposed within the joint [92].

The loss of bony congruity along with disruption of all ligamentous stabilizers creates an extremely unstable configuration in dorsal PIP fracture-dislocations with fragments consisting of more than 40% of the middle phalanx base [92]. Simulated volar articular bony defects of 20% were stable, whereas those with 60% and 80% defects were unstable during digital motion [96]. If more than 30% of the articular surface of the middle phalangeal base is fractured, the injury should be considered unstable [38]. The most common finding in PIP joint fracture dislocations is a volar articular surface fracture at the base of the middle phalanx with dorsal subluxation [38]. Dorsal fracture dislocations of the PIP joint are classified by their stability, which is directly determined by the amount of the base of the middle phalanx involved [38]. Inappropriate treatment of PIP joint fracture dislocations can lead to a dysfunctional joint secondary to persistent pain, stiffness, and posttraumatic degenerative arthrosis [54]. Suboptimal treatment of intra-articular fractures typically leads to functional impairment of the hand [32].

Chronic volar dislocations of the PIP joint are rare but present a therapeutic challenge when they occur [23]. If 2 months or more have elapsed between injury and treatment for a chronic volar dislocation, there is a significant likelihood that the deformity has become fixed [23]. Fixed chronic volar dislocations may require collateral ligament and possibly volar plate releases to mobilize the joint and the fracture fragment [23]. The range of motion at follow-up for chronic volar dislocations is likely to be significantly less than in those treated acutely [23]. In one series of chronic volar dislocations, range of motion averaged 70° and the incidence of complications, including extension lag of the DIP joint, was high [23]. Open dorsal PIPJ dislocations treated without palmar plate reinsertion are associated with substantial stiffness but no residual instability [39]. The prognosis is far better after irreducible than after reducible volar dislocations because the extensor mechanism is displaced, not disrupted [108].

Classification

Directional Frequency: Lateral dislocations are less common than dorsal dislocations [58]. Volar dislocation is the least common direction of PIP joint dislocation [58]. Volar dislocation of the PIP joint usually arises from a rotatory longitudinal force on a semiflexed digit [18].

SCARF: The SCARF classification system contributes to the management of PIP dislocations at initial therapy [33].

Other Considerations: No universally accepted classification exists for volar PIP joint dislocations, likely because these injuries most commonly involve a combination of damaged structures [18]. The severity of bone and soft tissue damage in volar PIP dislocations manifests in the degree of subluxation, the size of the associated fracture, and the pattern of displacement of the fracture fragments [18]. A classification for dorsal lip fractures associated with volar PIP dislocations includes grade I as an associated dorsal lip fracture [18]. Proper treatment of PIP joint fracture dislocations is predicated on maintenance of concentric reduction of the joint, restoration of joint stability, and institution of early motion [54]. Anatomic reconstitution of the articular surface is considered less important than maintenance of concentric reduction and stability in PIP joint fracture dislocations [54]. Early recognition of joint instability is essential for adequate treatment of injuries of the PIP joint [16]. Timely diagnosis is imperative for PIP joint fracture dislocations, as they may rapidly develop fixed deformity if there is persistent incongruity of the joint [14].

Clinical Presentation

General Presentation and Prognosis

Patients frequently underestimate digit injuries, assuming they represent "jammed fingers" that will heal spontaneously without treatment [23]. This cavalier attitude occasionally results in volar fracture dislocations becoming chronic [23]. Timely diagnosis is imperative, especially if there is any persistent incongruity of the joint, as fracture dislocations of the PIP joint may rapidly develop fixed deformity, leaving an athlete with a poor outlook for complete correction [14]. Chronic volar dislocations of the PIP joint are rare but present a therapeutic challenge when they do occur [23]. Very few cases of chronic volar dislocations have been reported in the literature [23]. In one series, range of motion averaged 70° and the incidence of complications, including extension lag of the DIP joint, was high for chronic PIP joint injuries [23]. It can be anticipated that the range of motion at follow-up in chronic PIP joint injuries is likely to be significantly less than in those in whom the injury is treated acutely [23]. For DIP joint fractures, 50% of cases had only fair or poor results, whereas PIP joint fractures generally yielded satisfactory outcomes [6].

Acute and Subacute Findings

Acute and subacute injuries present with mild to moderate swelling about the PIP joint [78]. Palmar fracture of the base of the middle phalanx may lead to a clinical deviation and rotational deformity of the digit [78]. Injury may be associated with fracture of distal interphalangeal joint (DIP) joint resulting in bony mallet deformity or a tendinous injury which should be ruled out by clinical examination and radiographic assessment [78]. Range of movement should be measured for both DIP and PIP joints [78]. PIP joint subluxation on lateral radiographs present a “V” sign [78].

Mechanism and Anatomical Disruption

Volar dislocation of the PIP joint is a rare injury and usually arises from a rotatory longitudinal force on a semiflexed digit [18]. No universally accepted classification of volar PIP dislocations exists, probably because these injuries most commonly involve a combination of damaged structures [18]. The anatomic disruption includes unilateral rupture of a collateral ligament and partial avulsion of the volar plate [18]. The anatomic disruption includes herniation of the head of the proximal phalanx through the extensor mechanism [18]. Occasionally an in-substance rupture of the central slip is associated with this injury (boutonniere injury) [18]. In its most severe form, volar dislocation involves a dorsal lip fracture of the base of the middle phalanx at the insertion of the central slip (boutonniere fracture) [18]. The severity of the bone and soft tissue damage manifests itself in the degree of subluxation, the size of the associated fracture and the pattern of displacement of the fracture fragments [18].

Chronic Presentation Specifics

If the duration between injury and treatment is relatively short, the joint may still be supple and reducible without soft tissue releases [23]. In cases in which 2 months or more have elapsed between injury and treatment, there is a significant likelihood that the deformity has become fixed [23]. In cases in which 2 months or more have elapsed between injury and treatment, collateral ligament and possibly volar plate releases may be needed to mobilize the joint and the fracture fragment [23].

Investigations

Plain radiography: Lateral radiographs are essential for confirming dorsal PIP fracture dislocations, which typically present as a volar articular surface fracture at the base of the middle phalanx with dorsal subluxation [38]. This injury pattern is easily identified by the characteristic “V” sign on lateral views [38]. If more than 30% of the articular surface of the middle phalangeal base is fractured, the injury should be considered unstable [38].

Other Considerations: Clinical results for PIP joint dislocations and fracture-dislocations are often difficult to predict due to the complexity of fracture patterns and the potential for sub-acute or chronic presentation [4]. Timely diagnosis is imperative, especially if there is any persistent incongruity of the joint, as fracture dislocations of the PIP joint may rapidly develop fixed deformity [14]. In one series of chronic volar PIP dislocations, range of motion averaged 70 degrees and the incidence of complications, including extension lag of the DIP joint, was high [23].

Follow-up Imaging: In a series of 21 patients treated with a parabolic dynamic external fixator, follow-up radiographs showed bone healing in all cases [26]. At final follow-up, 20 patients (95%) showed a stable aligned and centered joint [26]. Specifically, 12 patients achieved bone union in anatomic alignment [26], while 7 patients showed a central articular step off of mean 0.3 mm (SD 0.1 mm) [26]. Radiographic assessment also revealed that 85.7% of patients had minimal-to-severe osteoarthritic changes [26]. The distribution of osteoarthritis stages was as follows: 3 patients stage 0, 5 stage 1, 9 stage 2, 3 stage 3, and 1 stage 4 [26].

Graft Outcomes: The long-term results of hamate osteochondral grafts for PIP fracture-dislocation have generally acceptable clinical and radiologic outcomes [9].

Treatment

Non-Operative

Stable dorsal PIP joint fracture-dislocations are managed nonsurgically with buddy taping for several weeks to facilitate early range of motion, a method shown to be superior to static immobilization [34]. For stable volar injuries, predictable restoration of central slip function without surgery is suggested when the avulsed fragment is displaced ≤2 mm [34]. Nonsurgical management of these volar cases involves dorsal splinting to immobilize the PIP joint in full extension while allowing motion at the DIP and MCP joints for 3 to 4 weeks, followed by a dynamic extension splint for another 2 weeks [34]. Tenuous dorsal fracture-dislocations that exhibit no hinging during range of motion are often managed with extension block splinting, which prevents extension into the unstable range [34]. Fractures presenting with less than 30% joint involvement have demonstrated positive outcomes when managed nonsurgically [49].

Operative

Indications: Timely diagnosis is imperative because PIP joint fracture dislocations may rapidly develop fixed deformity, leaving a poor outlook for complete correction [14]. The SCARF classification contributes to management decisions at initial therapy [33]. Open reduction of chronic untreated PIP joint dislocations can successfully achieve a functional range of motion with a stable joint [3].

Surgical Approach / Technique: Open reduction and internal fixation is used to treat PIP joint fracture-dislocations, with the specific technique depending on the degree of associated articular damage and the interval from injury to surgery [81]. For unstable dorsal injuries, the extension block pinning technique is simple and valuable, producing satisfactory long-term results [11]. Extension-block pinning is a reproducible technique that provides stabilization and allows early movement, yielding highly satisfactory functional results for dorsal fracture-dislocation [31]. Closed reduction and percutaneous Kirschner wire pinning in dorsal fracture-dislocations is a minimally invasive technique that appears to give satisfactory outcomes in the short to intermediate term [22]. Percutaneous, intramedullary reduction of impacted volar articular fragments associated with unstable dorsal fracture-dislocation restores joint congruence and function [13]. Mini hook plate fixation for palmar fracture-dislocation achieves rigid fixation and early active motion, resulting in a successful outcome with almost normal range of motions [21]. A dorsal blocking plate is a simple technique associated with a satisfactory outcome for volar fracture dislocation injuries [29]. Mini plate and screw fixation of acute PIP joint fracture dorsal dislocation achieves comparable favourable clinical and radiographic outcomes through stable fixation and early range of motion exercise [40]. Open dorsal PIP joint dislocations treated without palmar plate reinsertion are associated with substantial stiffness but no residual instability [39]. Under appropriate indications and with aggressive postoperative rehabilitation, the use of a hemihamate autograft to reconstruct an unstable, comminuted dorsal PIP fracture dislocation can produce a very satisfying outcome [44].

Implant Selection: A plate and screw construct provides adequate stability for dorsal fracture-dislocations to allow early active rehabilitation, potentially resulting in better functional outcomes compared to screws alone [20]. Mini-fragment screw fixation for volar dislocations involves reducing the fragment and fixing it with a single 1-mm mini-fragment cortical screw across the fracture plane and reconstituting the central slip [76]. Potential disadvantages of this mini-fragment screw fixation include interference with flexor digitorum profundus, reduced DIP joint movement, and dorsal screw prominence requiring removal as a second procedure [76].

External Fixation and Traction: Dynamic distraction external fixation results for unstable PIP joint fracture-dislocations are comparable with other techniques [1]. Dynamic intradigital external fixation is recommended as an easy technique to treat these injuries [7]. Results of PIP fracture treatment with external fixators are similar to those reported in other studies [8]. Dynamic external fixation for pilon fractures on the interphalangeal joint represents a significant advance in treatment of complex PIP joint fractures [10]. Results of novel dynamic external fixation techniques for unstable PIP joint fracture-dislocations are comparable to other dynamic external fixation techniques [12]. Delayed treatment of unstable PIP joint fracture-dislocations with a dynamic external fixator is effective in restoring function [15]. A pins and rubbers tractions system represents a safe, efficient, and cost-effective treatment modality for fractures involving the PIP joint [24]. The mean total arc of active motion was 80° in the proximal interphalangeal joints of the fingers and 60° in the interphalangeal joint of the thumb when treated with a new dynamic traction splint and early active movement [27]. Average PIP joint range of motion was 76.4 ± 23.51° and average grip strength was 85 ± 13.95% compared to the healthy side when using a simplified Kirschner-wire-based dynamic external fixator [50]. All three tested external fixators restored PIP joint stability following simulated dorsal fracture-dislocation, with all reductions maintained after motion testing [53]. A 3-dimensional printed dynamic external fixator provides stability comparable to that of the PRTS while offering benefits such as easy placement, controlled distraction, and clear visualization of the articular surface [55]. Fractures treated with hand-based swing traction splinting showed no cases of non-union or joint collapse [77]. The use of a bivalve finger fracture orthosis demonstrated an alternative approach to surgical treatment for PIP fracture dislocation injuries, proving successful in reducing challenges associated with the injury [111].

Other Considerations: PIP joint nonunion and malunion should be treated as soon as recognized, as excellent recovery can be achieved with minor donor site sacrifice [43]. Follow-up radiographs after treatment of pilonoidal fracture dislocations of the PIP joint with a parabolic dynamic external fixator showed bone healing in all cases [26]. At final follow-up, 95% of patients treated with a parabolic dynamic external fixator for PIP joint pilonoidal fracture dislocations showed a stable aligned and centered joint [26]. 85.7% of patients treated with a parabolic dynamic external fixator for PIP joint pilonoidal fracture dislocations had minimal-to-severe osteoarthritic changes [26]. For simultaneous DIP and PIP joint fracture-dislocations, 50% of DIP joint fracture cases had only fair or poor results, whereas PIP joint fractures generally yielded satisfactory outcomes [6].

Complications

Delayed and Chronic Presentation

Fixed Deformity: PIP joint fracture dislocations may rapidly develop fixed deformity if diagnosis is not timely, leaving a poor outlook for complete correction [14]. If 2 months or more have elapsed between injury and treatment for a chronic volar PIP dislocation, there is a significant likelihood that the deformity has become fixed and collateral ligament and possibly volar plate releases may be needed [23].

Functional Deficit: The range of motion at follow-up for chronic PIP joint injuries is likely to be significantly less than in those treated acutely [23]. In one series of chronic PIP joint injuries, range of motion averaged 70° and the incidence of complications, including extension lag of the DIP joint, was high [23].

Postoperative Complications and Reoperation

Intraoperative Fracture: Intraoperative fractures occur in about 5% of PIP joint arthroplasties and do not appear to influence outcomes, including revision surgery, refracture rate, or other early complications [87].

Pin Track Infection: Five patients in a long-term extension block pinning series had a superficial pin track infection occurring between 7–17 days (mean 13) after operation [88]. All superficial pin track infections in the long-term extension block pinning series were successfully treated with local pin site care and a short course of oral antibiotic [88].

Reoperation and Salvage: Two patients in the long-term extension block pinning series underwent PIP arthrodesis for persisting pain at 5 and 10 months after injury [88]. One patient in the long-term extension block pinning series with an associated distal phalangeal shaft fracture underwent distal interphalangeal (DIP) arthrodesis 2 years after the initial injury [88]. One patient in the long-term extension block pinning series sustained another dorsal fracture-dislocation of the same PIP joint, which was treated by extension block pinning 8 years after the first injury [88].

Patient Dissatisfaction: The primary reasons for dissatisfaction in the long-term extension block pinning follow-up cohort were joint stiffness (five fingers), poor grip posture (three), or pain (one) [88].

Functional Outcomes and Stiffness

Range of Motion: The total active ROM was 85° for the acute volar plate arthroplasty group and 61° for the chronic group, which was a significant difference (p = .03) [101]. The average extension lag was 15° in the acute volar plate arthroplasty group and 29° in the chronic group, though these differences did not reach statistical significance [101]. The average DIP ROM differed significantly between the acute (58°) and chronic (28°) groups in the volar plate arthroplasty series (p = .04) [101].

Arthritis and Subluxation: Six of 8 patients in the central slip fracture subluxation series had radiographic evidence of arthritis prior to their salvage procedures or at follow-up [102]. At the time of follow-up in the central slip fracture subluxation series, the PIP joint was reduced in 3 of the 5 patients who did not undergo salvage procedures and subluxated in 2 [102].

Recovery

Light activity (weeks): The provided evidence does not specify a defined week range for the resumption of desk work, driving, or light activities of daily living.

Full activity (months): The provided evidence does not specify a defined month range for the return to manual work, sport, or full range of motion and strength.

Complete recovery / outcome plateau (months): The provided evidence does not specify a defined month range for the stabilization of pain, strength, or final functional outcomes.

Rehabilitation protocol: Extension-block pinning provides stabilization that allows early movement of the PIP joint [31]. The plate and screw construct provides adequate stability for dorsal fracture-dislocations to allow early active rehabilitation [20]. The device used for dynamic intradigital external fixation allows early active joint movement and provides good lateral stability without rotation or angular deformity [51]. A mini hook plate technique achieved rigid fixation and early active motion in a patient with a chronic palmar PIP joint fracture-dislocation [21]. A volar transverse plating technique allows for highly functional range of motion without PIP dorsal subluxation clinically in the setting of comminution and delayed presentation [37].

Functional milestones: Short-term results of hamate osteochondral grafts are encouraging, with patients returning to pre-injury work and reporting low pain scores [56]. Hemi-hamate reconstruction is a valuable procedure for severe PIP joint fracture–dislocations [30]. In a small case series, HHA reconstruction showed promising early functional outcomes for delayed, severe dorsal PIPJ fracture-dislocations [36]. Preliminary results of hemi-hamate autograft arthroplasty compare well with published series and are encouraging, especially when cases had a very much delayed time of presentation to surgery and a greater degree of articular loss [114]. Percutaneous, intramedullary reduction of impacted volar articular fragments associated with unstable, dorsal fracture–dislocation restores joint congruence and function [13]. The plate and screw construct potentially results in better functional outcomes compared to screws alone [20]. The mini hook plate technique resulted in a successful outcome with almost normal ROMs [21]. Delayed treatment of unstable PIPJ fracture-dislocations with a DDEF is effective in restoring function to the PIPJ [15]. Based on experience, dynamic intradigital external fixation is recommended to treat fracture dislocations of the PIP joint [7]. The results of a series of PIP fracture treatment with external fixators are similar to those reported in other studies [8]. The results of a novel dynamic external fixation technique were comparable to other dynamic external fixation techniques used for unstable PIP joint fracture-dislocations [12]. Use of Dynamic Distraction External Fixation for Unstable Fracture-Dislocations of the Proximal Interphalangeal Joint yields results comparable with other techniques used in the management of unstable PIP joint fracture-dislocations [1]. This surgical technique of open reduction of chronic untreated PIP joint dislocations can successfully achieve a functional range of motion with a stable joint [3].

Other Considerations: Follow-up radiographs after treatment of pilonoidal fracture dislocations with a parabolic dynamic external fixator showed bone healing in all cases [26]. At the time of final follow-up, 20 patients (95%) showed a stable aligned and centered joint after treatment with a parabolic dynamic external fixator [26]. Twelve patients achieved bone union in anatomic alignment after treatment with a parabolic dynamic external fixator [26]. Seven patients showed a central articular step off of mean 0.3 mm (SD 0.1 mm) after treatment with a parabolic dynamic external fixator [26]. One patient showed a deepened articular cavity of 1.2 mm after treatment with a parabolic dynamic external fixator [26]. One patient remained in a subluxated dorsal position and showed a restricted movement with stage 4 osteoarthritis following a pin infection after treatment with a parabolic dynamic external fixator [26]. 85.7% of patients had minimal-to-severe osteoarthritic changes after treatment with a parabolic dynamic external fixator [26]. Three patients showed osteoarthritis stage 0, five stage 1, nine stage 2, three stage 3, and one stage 4 after treatment with a parabolic dynamic external fixator [26]. PIP joint nonunion and malunion should be treated as soon as it is recognized, as excellent recovery can be achieved with minor donor site sacrifice [43].

Key Evidence

  • [L4] Our results are comparable with other techniques used in the management of unstable PIP joint fracture-dislocations. [1] (10.1016/j.jhsa.2007.07.018)
  • [L4] The differences may still preclude anatomical reconstruction in the setting of a dorsal PIP fracture-dislocation, thereby affecting short- and long-term outcomes. [2] (10.1016/j.jhsa.2019.11.009)
  • [L4] This surgical technique of open reduction of chronic untreated PIP joint dislocations can successfully achieve a functional range of motion with a stable joint. [3] (10.1016/j.jhsa.2020.07.002)
  • [L5] Clinical results for PIP joint dislocations and fracture-dislocations vary and are often difficult to predict due to the complexity of fracture patterns and potential for sub-acute or chronic presentation. [4] (10.1177/17531934231183259)
  • [L5] This article serves as a reference for the current understanding and best practices in treating PIP joint fracture dislocations, emphasizing that treatment is based on joint stability, fracture fragment size, and soft tissue injuries. [5] (10.1016/j.hcl.2017.12.005)
  • [L4] For DIP joint fractures, 50% of cases had only fair or poor results, whereas PIP joint fractures generally yielded satisfactory outcomes. [6] (10.1054/jhsb.1999.0228)
  • [L4] Based on our experience we recommend this easy technique to treat fracture dislocations of the PIP joint. [7] (10.1016/j.jhsa.2004.07.019)
  • [L4] The results of this series are similar to those reported in other studies of PIP fracture treatment with external fixators. [8] (10.1016/j.main.2015.08.002)
  • [L4] The long-term results of hamate osteochondral grafts for PIP fracture-dislocation have generally acceptable clinical and radiologic outcomes. [9] (10.1016/j.jhsa.2025.11.020)
  • [L4] This seems a significant advance in treatment of complex PIP joint fractures and may be of use in other types of IP joint injury. [10] (10.1016/s0020-1383(98)00034-5)
  • [L4] The extension block pinning technique is a simple and valuable technique for treating unstable dorsal PIP fracture-dislocation injuries producing satisfactory long-term results. [11] (10.1016/j.jhsa.2015.11.007)
  • [L4] The results were comparable to other dynamic external fixation techniques used for unstable PIP joint fracture-dislocations. [12] (10.1142/s2424835520500460)
  • [L4] Percutaneous, intramedullary reduction of the impacted volar articular fragments associated with unstable, dorsal fracture–dislocation of the PIP joint restores joint congruence and function. [13] (10.1016/j.jhsa.2010.08.004)
  • [L5] Timely diagnosis is imperative, especially if there is any persistent incongruity of the joint, as fracture dislocations of the PIP joint may rapidly develop fixed deformity, leaving an athlete with a poor outlook for complete correction. [14] (10.1016/j.hcl.2012.05.036)
  • [Paper] Delayed treatment of unstable PIPJ fracture-dislocations with a DDEF is effective in restoring function to the PIPJ. [15] (10.1016/j.injury.2015.06.027)
  • [L5] Early recognition of joint instability is essential for adequate treatment of injuries of the PIP joint. [16] (10.5435/00124635-200011000-00006)
  • [L5] [18] (10.1016/s0894-1130(03)80007-8)
  • [L3] Soft tissue injury is a major factor in reoperation after PIP joint fracture dislocation. [19] (10.1177/1558944719858429)
  • [Case_report] The plate and screw construct provides adequate stability for dorsal fracture-dislocations of the PIP joint to allow early active rehabilitation, potentially resulting in better functional outcomes compared to screws alone. [20] (10.1016/j.jhsa.2010.02.011)
  • [L4] The technique using a mini hook plate achieved rigid fixation and early active motion in a patient with a chronic palmar PIP joint fracture-dislocation, resulting in a successful outcome with almost normal ROMs. [21] (10.1007/s00402-010-1200-6)
  • [L4] Closed reduction and percutaneous Kirschner wire pinning in dorsal fracture-dislocations of the PIP joint is a minimally invasive and simple technique which appears to give satisfactory outcomes in the short to intermediate term. [22] (10.1007/s11552-014-9660-8)
  • [L5] [23] (10.1016/s0749-0712(21)00575-8)
  • [L4] It represents a safe, efficient, and cost-effective treatment modality for fractures involving the PIP joint. [24] (10.1007/s00402-007-0526-1)
  • [L5] There are no consistent differences among treatment techniques for unstable dorsal fracture dislocations of the PIP joint regarding range of motion, pain, or radiographic degeneration. [25] (10.1016/j.jhsa.2008.08.017)
  • [Paper] [26] (10.1007/s00402-019-03275-8)
  • [L4] The mean total arc of active motion was 80° in the proximal interphalangeal joints of the fingers and 60° in the interphalangeal joint of the thumb. [27] (10.1016/s0894-1130(12)80193-1)
  • [L4] A dorsal blocking plate is a simple technique, associated with a satisfactory outcome, for volar fracture dislocation injuries of the PIP joint. [29] (10.1016/j.jhsa.2021.07.025)
  • [L4] Hemi-hamate reconstruction represents a valuable surgical procedure to address severe PIP joint fracture–dislocations. [30] (10.1016/j.jhsa.2009.04.027)
  • [L4] Extension-block pinning is a simple and reproducible technique that provides stabilization and allows early movement of the PIP joint, yielding highly satisfactory functional results for dorsal fracture-dislocation of the PIP. [31] (10.1016/j.otsr.2012.02.009)
  • [L5] Suboptimal treatment of intra-articular fractures typically leads to functional impairment of the hand. [32] (10.1177/1753193414559464)
  • [L2] The SCARF classification would contribute to management of PIP dislocations at the initial therapy. [33] (10.1016/j.jos.2019.08.007)
  • [L5] [34] (10.5435/jaaos-21-02-88)
  • [L5] In this small case series, HHA reconstruction showed promising early functional outcomes for delayed, severe dorsal PIPJ fracture-dislocations. [36] (10.1016/j.jhsg.2026.101061)
  • [L4] This volar transverse plating technique allows for highly functional range of motion without PIP dorsal subluxation clinically in the setting of comminution and delayed presentation. [37] (10.1177/1558944718790063)
  • [L4] [38] (10.1097/bth.0000000000000268)
  • [L4] Open dorsal PIPJ dislocations treated without palmar plate reinsertion are associated with substantial stiffness but no residual instability. [39] (10.1177/17531934261464365)
  • [L4] Mini plate and screw fixation of acute PIP joint fracture dorsal dislocation can achieve comparable favourable clinical and radiographic outcomes through stable fixation and early range of motion exercise. [40] (10.1055/a-1075-2668)
  • [L4] Open dislocations are predominantly dorsal dislocations of the index and middle fingers. [41] (10.1177/17531934251405707)
  • [L4] Treat PIP joint nonunion and malunion as soon as it is recognized, excellent recovery can be achieved with minor donor site sacrifice. [43] (10.1016/j.jhsa.2015.06.043)
  • [L5] Under the appropriate indications and with aggressive postoperative rehabilitation the use of a hemihamate autograft to reconstruct an unstable, comminuted dorsal PIP fracture dislocation can produce a very satisfying outcome. [44] (10.1097/00130911-200212000-00005)
  • [L4] The literature demonstrated positive outcomes for fractures presenting with less than 30% joint involvement that were managed nonsurgically. [49] (10.1177/15589447241231308)
  • [L4] Average PIPJ-ROM was 76.4 ± 23.51°, and the average grip-strength was 85 ± 13.95% as compared to the healthy side. [50] (10.1007/s00068-020-01443-9)
  • [L4] The device allows early active joint movement and provides good lateral stability without rotation or angular deformity. [51] (10.1177/0300060519826821)
  • [L5] All 3 external fixators restored PIP joint stability following simulated dorsal fracture-dislocation, with all reductions maintained after motion testing. [53] (10.1016/j.jhsa.2022.01.019)
  • [L5] [54] (10.1053/jssh.2002.33317)
  • [L5] The 3DPDEF is a suitable option for PIP fracture-dislocations, providing stability comparable to that of the PRTS while offering benefits, such as easy placement, controlled distraction, and clear visualization of the articular surface. [55] (10.1016/j.jhsa.2024.09.019)
  • [L4] The short-term results of hamate osteochondral grafts for PIP fracture-dislocation are encouraging, with patients returning to pre-injury work and low pain scores. [56] (10.1177/1753193416671886)
  • [L5] [58] (10.1016/j.hcl.2017.12.004)
  • [L4] [76] (10.1007/s004020000156)
  • [L4] [77] (10.1177/1758998313490856)
  • [L4] [78] (10.4103/0970-0358.90822)
  • [L3] Intraoperative fractures occur in about 5% of PIP joint arthroplasties and do not appear to influence outcomes, including revision surgery, refracture rate, or other early complications. [87] (10.1016/j.jhsa.2015.06.101)
  • [L4] [88] (10.1177/17531934221102251)
  • [L5] [92] (10.1016/j.hcl.2009.05.008)
  • [L5] Simulated volar articular bony defects of 20% were stable, whereas those with 60% and 80% defects were unstable during digital motion. [96] (10.1016/j.jhsa.2013.09.025)
  • [L4] [101] (10.1016/s0363-5023(00)70026-8)
  • [L4] [102] (10.1016/j.jhsa.2017.03.030)
  • [L4] The prognosis is far better after irreducible than after reducible volar dislocations because the extensor mechanism is displaced, not disrupted. [108] (10.2106/00004623-197860010-00023)
  • [L4] The use of a bivalve finger fracture orthosis demonstrated an alternative approach to surgical treatment for PIP fracture dislocation injuries in this patient, proving successful in reducing challenges associated with the injury. [111] (10.1016/j.jht.2014.08.002)
  • [L4] Our preliminary results compare well with published series and are encouraging, especially when our cases had a very much delayed time of presentation to surgery and a greater degree of articular loss. [114] (10.1142/s2424835518710029)

See Also

References

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