Orthopedics Book

Cardiovascular Medicine

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Flexor Surface Injury at the PIP Joint

Aka: Flexor Surface Injury at the PIP Joint, PIP Joint Volar Plate Injury, Volar Plate Injury
  1. Mechanism
    1. Volar plate injured in hyperextension of affected joint
      1. Usually affects PIP joint
      2. Partial or complete tear or avulsion Fracture
      3. Often occurs when the finger is dislocated dorsally
    2. Associated with PIP Collateral Ligament Injury
  2. Signs
    1. Tenderness at affected joint at volar aspect
    2. Evaluate collateral ligaments for stability
    3. Range of motion remains intact if stable joint
  3. Imaging: XRay
    1. Avulsion Fracture may be present
  4. Management
    1. Referral indications
      1. Unstable joint
      2. Large avulsion Fracture
    2. Moderate, but stable injury (most cases)
      1. Progressive extension splint (block splint)
      2. Aluminum splint initially angled 30 degrees flexion
      3. Progressively decrease flexion weekly by 5-10 degrees
        1. Week 1-2: 30 degrees
        2. Week 2-3: 20 degrees
        3. Week 3-4: 10 degrees
        4. Week 4: Full extension
      4. Buddy taping for an additional 2 weeks
    3. Mild injury
      1. Buddy taping to adjacent finger for 4 weeks
    4. Sport participation
      1. May participate if splinted or buddy taped
  5. Complications
    1. Hyperextension deformity
  6. References
    1. Leggit (2006) Am Fam Physician 73(5):810-23 [PubMed]

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