From the Research
The treatment for a PIP joint dislocation with possible central slip injury requires prompt reduction followed by appropriate splinting to prevent boutonnière deformity, with the most recent and highest quality study suggesting closed reduction with percutaneous pinning and volar plate arthroplasty having good clinical and functional outcomes, with the lowest complication rates 1.
Key Considerations
- Prompt reduction is essential to prevent further injury and promote healing.
- Testing for central slip injury by having the patient actively extend the PIP joint against resistance is crucial in determining the appropriate treatment.
- Immobilization of the PIP joint in full extension with a dorsal splint for 6 weeks, while allowing DIP joint motion, is recommended if a central slip injury is suspected.
- Buddy taping to an adjacent finger with early protected motion is suitable for simple dislocations without central slip injury.
Treatment Approach
- Pain management includes NSAIDs such as ibuprofen 400-600mg every 6 hours and acetaminophen 1000mg every 6 hours as needed.
- Ice application for 15-20 minutes several times daily helps reduce swelling.
- Follow-up evaluation within 7-10 days is essential to reassess stability and adjust treatment.
- Physical therapy focusing on range of motion exercises should begin after the immobilization period to prevent stiffness.
Importance of Early Treatment
- Untreated central slip injuries can lead to permanent boutonnière deformity with PIP flexion and DIP hyperextension.
- Early controlled mobilisation has become increasingly important, and therefore, splints have had to be adapted to allow for this, as seen in the figure-of-eight splint yielding excellent results 2.
- The treatment of PIPJ dislocations has undergone a significant evolution, with a shift from complete immobilisation to controlled early mobilisation 2.