Management of proximal interphalangeal joint injuries

Abstract

A Freiberg. Management of proximal interphalangeal joint injuries. Can J Plast Surg 2007;15(4):199-203. Injuries to the proximal interphalangeal joint are common but frequently missed. They are often overtreated by prolonged immobilization, resulting in stiffness, which may be permanent. The purpose of the present article is to briefly review the relevant anatomy and biomechanics, present an approach to physical examination and diagnosis, and propose a practical clinical classification. The treatment of the most severe injury -the intra-articular fracture dislocation -is controversial. The various treatment options are discussed, based on personal experience and a review of the literature. A list of relevant references is presented.Key Words: Management; Proximal interphalangeal joint injuries; Review of literature La prise en charge des lésions des articulations interphalangiennes proximalesLes lésions des articulations interphalangiennes proximales sont courantes, mais passent souvent inaperçues. Par ailleurs, elles sont souvent trop traitées par une immobilisation prolongée, ce qui provoque une raideur qui risque de devenir permanente. Le présent article vise à analyser brièvement l'anatomie et la biomécanique pertinentes, à présen-ter un mode d'examen physique et de diagnostic et à effectuer une classification clinique pratique. Le traitement de la lésion la plus grave, la fracture-luxation intra-articulaire, est controversé. On expose les diverses possibilités de traitement, d'après l'expérience personnelle et une analyse bibliographique. On présente également une liste de références pertinentes.

Current Concepts in Treatment of Fracture-Dislocations of the Proximal Interphalangeal Joint

“…The management of these injuries must be proactive, restoring mobility as soon as feasible, to prevent stiffness and disability. Freiberg stated, “In general, when dealing with finger fractures and dislocations, one must always remember that for every case of delayed or nonhealing fracture, there are at least 100 permanently stiff fingers.” 2 This statement resonates with all experienced hand surgeons, underscoring the importance of correct management of these injuries, which must include early motion whenever feasible.…”

“…Disruption of any one side of the box does not typically lead to dislocation; rather, at least two of these structures must be disrupted for the joint to dislocate. 2 …”

“…8 Early motion is the most important component of treatment, as prolonged immobilization leads to significant difficulty with stiffness. Although this concept is stressed in most review articles on this subject, 2,9,10 there is little high-level evidence to support this. Arora et al published a retrospective study comparing 4 weeks cast immobilization versus early active motion following reduction of PIPJ dorsolateral dislocations.…”

Volar Plate Avulsion of Pip Joint: An Unusual Fielding Injury in Cricket

“…The PIP joint is a simple hinge and receives most of its stability from the surrounding soft tissue structures. 14 The capsule is reinforced in a box-like fashion by the collateral and accessory collateral ligaments laterally, and the volar plate anteriorly. 14 The function of the volar plate is largely to stabilize the joint in the anterior-posterior (AP) plane and resist hyperextension.…”

“…14 The capsule is reinforced in a box-like fashion by the collateral and accessory collateral ligaments laterally, and the volar plate anteriorly. 14 The function of the volar plate is largely to stabilize the joint in the anterior-posterior (AP) plane and resist hyperextension. 14 It forms a strong distal attachment to the periosteum of the middle phalanx, while the proximal portion just attaches to the capsule.…”