Does a pip (proximal interphalangeal) finger joint avulsion fracture require an ulnar gutter splint?

From the Guidelines

A pip finger joint avulsion fracture typically requires an ulnar gutter splint for proper immobilization and healing. The ulnar gutter splint should be applied with the PIP joint in slight flexion to prevent extensor lag, while maintaining the metacarpophalangeal (MCP) joint at about 70-90 degrees of flexion, as simple immobilization is appropriate when fracture fragments are small, nonarticular, or minimally displaced 1.

Key Considerations

• The splint should extend from the fingertip to the mid-forearm, immobilizing the affected finger and adjacent digits for stability.
• The recommended duration for splinting is generally 3-4 weeks, followed by protected motion and gradual rehabilitation.
• For pain management, acetaminophen or ibuprofen can be used as needed, and ice application for 15-20 minutes several times daily during the first 48-72 hours helps reduce swelling.

Immobilization and Rehabilitation

• The ulnar gutter splint is particularly effective for these injuries because it provides adequate immobilization while allowing for proper alignment of the fracture fragments, preventing rotational deformities and promoting healing in the correct anatomical position.
• Patients should be advised to keep the splint dry and clean, elevate the hand when possible to minimize swelling, and follow up within 7-10 days to assess healing progress with repeat radiographs, based on the diagnosis which is confirmed with radiographic studies 1.

From the Research

Treatment of Pip Finger Joint Avulsion Fracture

• The treatment of pip finger joint avulsion fracture requires careful consideration of the fracture type and the degree of displacement 2.
• Non-displaced fractures can be treated conservatively, while displaced fractures require anatomical reduction and surgical fixation 2.
• In cases where direct osteosynthesis is not possible, distraction devices, bone graft, or palmar plate reconstruction may be useful alternatives 2.

Use of Ulnar Gutter Splint

• There is no direct evidence in the provided studies to support the use of an ulnar gutter splint for pip finger joint avulsion fracture.
• However, the use of rational splinting and early, active, protected motion is emphasized in the management of proximal interphalangeal joint injuries 3.

Treatment Outcomes

• The outcomes of pip fractures and fracture-dislocations are based on the severity of injury, and the necessary treatment required 4.
• Closed reduction with percutaneous pinning and volar plate arthroplasty have been shown to have good clinical and functional outcomes, with low complication rates 4.