PIPJ dislocations

PIPJ Dislocations



- Dorsal

- Lateral

- Volar




Proper collateral ligaments

- primary stabilisers

- insert volar third of the base of PP


Accessory collateral ligaments

- inserts on and stabilises lateral margin of volar plate


Volar plate

- thick distally

- thin proximally, allowing collapse during flexion


Dorsal dislocations PIPJ


Most common joint injury of the hand

- hinge joint permitting 110o ROM

- volar plate fails distally

- collateral ligaments may be intact

- may be a fracture



- hyperextension

- axial loading of the flexed fingertip




Compound PIPJ dislocation



- dependant on integrity of the collateral ligaments

- if fragment is > 40 – 50%, the attachment of the true collateral ligament is lost

- unstable


Eaton Classification


I Simple hyperextension

- buddy strap, early ROM


II Dorsal dislocation

- reduced and assess stability

- buddy strap if stable

- extension splint 10o further than instability

- each week extend further by 10o

- early aggressive ROM program


Dorsal Dislocation Simple


IIIA  fracture < 40% volar articular surface

- closed treatment with extension block


Finger Dorsal Dislocation Extension Blocking Splint


IIIB fracture > 40% + Pilon fractures

- inherently unstable

- extension blocking requires extreme flexion for stability, so risk of flexion contracture is high

- aim for congruent articular surface and early ROM


PIPJ Dislocation and Large Bony Fragment


IIIB Treatment Options


1.  Dorsal Blocking K wire

2.  Slade Dynamic Distraction External Fixator

3.  Compass Hinge

4.  Volar Plate Arthroplasty


Dorsal Blocking K wire



- flexion P2

- dorsal entry into P1

- 40o flexion

- early removal at 3/52

- Improvement compared to extension blocking


Suzuki / Slade Dynamic Distraction external fixator



- closed reduction through ligamentotaxis

- early motion of PIPJ



- transverse K wire in rotational centre / head P1

- transverse K wire distal P2

- attached by rubber bands

- third K wire mid-diaphysis P2,  prevents dorsal translation of MP


Deshmuhk S etal JBJS Br July 2004

- 12 patients complex fracture dislocations PIPJ

- treated with modified pin / rubber band system

- average 84o ROM

- nil radiological osteolysis or clinical osteomyelitis

- all returned to occupation


Hotchkiss designed PIP compass hinge



- K wire to centre head of P1 to set centre rotation

- 2 x  K wires each in P1 / P2

- barrel over centre of rotation

- options of active motion, passive ROM, locked


Bain I JBJS Br 1998

- 12 patients

- mean range of motion 12 – 86o

- only half presented within 2 week of injury

- combined operation with ORIF and volar plate arthroplasty

- nil osteomyelitis

- hinge on for 6 weeks


Volar plate arthroplasty / Volar plate advancement



- incise accessory collaterals to release volar plate

- excise bony fragment

- suture proximal volar plate into defect

- pass sutures through drill holes in base P2

- tie over button dorsally

- dorsal blocking splint 4 - 6 / 52


Finger Volar Plate Arthroplasty


Volar PIPJ dislocations


Finger Volar DislocationFinger Post Volar Dislocation


A.  Straight volar dislocation


Assessment of central slip post reduction critical

- if can active extend to within 30o, splint extended

- if nil active, surgical repair to prevent boutonniere


B.  Volar rotary subluxation

- condyle button holes between central slip and lateral band

- irreducible dislocation


Lateral PIPJ dislocations


Rupture of one collateral ligament and volar plate

- may be bony avulsion



- reduce and hold in extension 2/52, then protected ROM

- can perform primary repair or reconstruct