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Condition

PIP Fracture-Dislocation

A combined fracture and joint dislocation at the middle knuckle of the finger. Easy to miss, and the difference between catching it early and catching it late is large.

What is a PIP fracture-dislocation?

The middle joint of the finger (the proximal interphalangeal, or PIP, joint) is held together by strong ligaments on three sides. In a PIP fracture-dislocation, a forceful injury — often a ball striking the fingertip, a finger caught in a jersey, or a fall onto the hand — breaks off a piece of the bone at the base of the middle phalanx (the small bone just past the knuckle) and lets the joint shift out of position.

These injuries often look deceptively mild at first. The finger may seem merely swollen and stiff. The appearance of a simple "jammed finger" can hide a joint that is subtly dislocated and an unstable fracture that will progress if it is not treated.

Common symptoms

  • Pain, swelling, and bruising at the middle joint of a finger after an injury
  • Obvious deformity of the finger, or a finger that does not look quite straight when compared to the others
  • Inability to fully bend or straighten the finger
  • A feeling of the joint "shifting" or giving way
  • Pain that does not improve after a few days of treating it as a jammed finger

Why it is easy to miss

The dislocated position of the joint in a PIP fracture-dislocation is sometimes subtle — an experienced eye looking at a good lateral x-ray can see it, but a quick read in a busy emergency department can miss it. A finger that is labeled a "jammed finger" and put in a splint for several weeks may come out of the splint with a joint that is permanently out of position and already stiffening. The key sign on a lateral x-ray is called the V sign — the dorsal edges of the bones form a V shape because the joint is not concentrically reduced.

Any finger injury that was dislocated at the scene, that has a visible fracture fragment on x-ray, or that remains painful and swollen after 7 to 10 days of splinting deserves a careful re-look with dedicated finger x-rays.

How it is diagnosed

  • Exam. Dr. Barrera will check the joint for stability and alignment, and will look for signs that the joint is subtly subluxed.
  • Dedicated finger x-rays (three views). A true lateral view of the individual finger is essential; a lateral of the whole hand is often not enough.
  • CT scan. Occasionally used when the fracture pattern is complex or when surgical planning requires a three-dimensional picture.

Treatment options

Treatment depends on how much of the joint surface is involved and whether the joint stays reduced (in position) during motion.

Stable injuries — small fragment, joint reduced

  • Extension-block splinting. A small splint is made that allows the finger to bend fully but blocks the last 20 to 30 degrees of straightening, so the fracture fragment stays reduced. The finger is moved actively within that arc from the very first days. Over 4 to 6 weeks the block is gradually reduced until the finger is fully straight. This can produce excellent results in the right injuries.

Unstable injuries — larger fragment, joint wants to dislocate

  • Closed reduction and percutaneous pinning. The joint is reduced under anesthesia and a small pin is used to hold the alignment while it heals.
  • Dynamic external fixation. A small external frame holds the joint reduced while allowing motion — useful for highly comminuted fractures where the joint surface is shattered.
  • Open reduction and internal fixation. For large, displaced fragments, the fragment is reassembled with small screws.
  • Hemi-hamate arthroplasty. When a large portion of the joint surface is destroyed, a small piece of bone from the wrist (the hamate) is used to rebuild the missing joint surface. This is a specialized technique that can preserve useful motion in injuries that would otherwise need a fusion or replacement.
  • Joint arthroplasty or fusion. Rarely needed acutely, but reserved for severely destroyed joints or as a salvage after missed injuries.

What to expect at your visit

Dr. Barrera will examine the finger, review dedicated lateral finger x-rays, and determine how much of the joint is involved and whether it stays reduced with motion. Many stable injuries do very well with extension-block splinting and early motion. Unstable injuries need operative fixation, and the specific operation is matched to the fracture pattern. Recovery typically takes 3 to 6 months for motion and strength to return, with hand therapy throughout.

Dr. Barrera's approach

The single most important thing in a PIP fracture-dislocation is getting the joint concentrically reduced and keeping it moving. A splinted-too-long PIP joint becomes permanently stiff, and a chronically subluxed joint develops arthritis. Dr. Barrera evaluates these injuries promptly, starts controlled motion as soon as the joint is stable, and uses hemi-hamate reconstruction or dynamic external fixation for the more severe fracture patterns.

When to call the office sooner

Call us if a finger joint is visibly deformed, if the finger cannot be straightened or bent, if a finger that has been treated as a jammed finger is not clearly improving after 7 to 10 days, or if pain and swelling are getting worse instead of better.

Related

Finger sprain (jammed finger) · Hand & finger fractures · Mallet finger

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