From the Guidelines
Treatment for a PIP finger joint avulsion fracture should prioritize early finger motion and aggressive hand therapy to prevent oedema and stiffness, with the goal of facilitating the best possible outcomes. When considering the management of such fractures, it's essential to focus on the level of evidence, barriers, and facilitators to effective implementation of clinical guidelines 1.
Key Considerations
- Early finger motion is crucial after immobilization to prevent stiffness and promote healing.
- Aggressive finger and hand motion is necessary to achieve the best possible outcomes.
- Range-of-motion exercises should begin early in the treatment process.
Given the importance of early mobilization, patients with PIP joint avulsion fractures should start range-of-motion exercises as soon as possible, ideally within the first few days after injury or surgery. This approach is supported by the principles outlined for managing fragility fractures, which emphasize the need for early motion to prevent complications such as stiffness 1.
Treatment Approach
- For stable fractures, conservative management with splinting and progressive motion protocol may be appropriate.
- For unstable fractures, surgical intervention may be necessary to ensure proper healing and joint stability.
- Pain management should include acetaminophen or NSAIDs, with follow-up visits to assess healing and adjust treatment as needed.
Follow-Up and Rehabilitation
- Follow-up visits should occur at 1-2 weeks and 4-6 weeks to evaluate healing, range of motion, and function.
- Physical therapy is beneficial to restore full motion and strength, typically starting around 4 weeks post-injury.
- Patients should be informed about potential complications, including stiffness, chronic pain, and post-traumatic arthritis, and the importance of adherence to the rehabilitation protocol to minimize these risks.
From the Research
Treatment Options for Pip Finger Joint Avulsion Fracture
- Conservative efforts generally include casting or splinting with a period of immobilization 2
- Surgery is typically indicated for more severe cases or if nonoperative treatments fail; patient demographics or preferences and surgeon experience may also play a role in decision making 2
- Screw fixation, when possible, may offer the best stability and compression at the fracture site and earlier mobilization and return to function 2
Follow-up and Rehabilitation
- Manual physical therapy following immobilization can be an effective approach to treating patients with conservatively managed fractures, with improvements in functional scale scores and ankle range of motion 3
- Early, active, protected motion is important for a favorable outcome in proximal interphalangeal joint injuries 4
- Accurate understanding of the regional anatomy and appreciation of the mechanism of injury allows for classification and formulation of a treatment protocol for each injury pattern 4
Potential Complications
- Avulsion fractures can lead to deformity, nonunion, malunion, pain, and disability if left untreated 2
- Late-presenting PIP joint fracture dislocations have a poor chance of regaining normal range of motion 5
- Physicians should be mindful of the potential complications associated with each intervention 2