Management of Subluxated PIP Joint with Good Reduction
After successful reduction of a subluxated proximal interphalangeal (PIP) joint in the left third digit, the recommended treatment is extension block splinting for 3-4 weeks followed by protected mobilization to optimize functional outcomes and prevent recurrent instability.
Initial Management
Splinting Protocol
- Apply an extension block splint that prevents hyperextension while allowing controlled flexion
- The splint should maintain the PIP joint in approximately 20-30° of flexion
- Immobilization period: 3 weeks is optimal for most cases 1
- Serial radiography should be performed to ensure maintained reduction 1
Activity Restrictions
- Avoid overuse of the injected joint for 24 hours following any intra-articular therapy 2
- Complete immobilization is discouraged as it may lead to joint stiffness 2
- Limit activities to light use during the splinting period
Monitoring and Follow-up
Radiographic Assessment
- Obtain follow-up radiographs at 1 week and 2-3 weeks post-reduction
- Plain radiographs provide the gold standard for morphological assessment 2
- Check for:
- Maintained joint reduction
- No evidence of further displacement
- Early signs of healing
Clinical Assessment
- Regular evaluation of:
- Pain levels
- Range of motion
- Functional impairment
- Signs of complications (swelling, erythema)
Rehabilitation Phase
Progressive Mobilization (Weeks 3-6)
- Begin controlled active range of motion exercises after 3 weeks
- Gradually discontinue splinting except during high-risk activities
- Consider buddy taping to adjacent finger for additional support
Pain Management
- Topical NSAIDs (particularly diclofenac gel) as first-line for pain control 3
- Oral analgesics only if needed for short duration 2
- Avoid intra-articular glucocorticoid injections unless there is significant inflammatory component 2
Special Considerations
Complications to Monitor
- Stiffness and contracture (most common)
- Recurrent instability or subluxation
- Post-traumatic arthritis
- Tendon adhesions
When to Consider Alternative Approaches
- If splinting fails to maintain reduction, consider surgical options 1, 4
- Extension-block pinning has shown excellent outcomes for unstable dorsal fracture-dislocations with minimal long-term disability 4
- Mini-external fixation devices may be considered for complex cases 5
Prognosis
- With proper management, 70% of patients with dorsal fracture subluxation of the PIP joint treated with extension block splinting achieve good results 1
- Functional impairment in hand injuries may be severe, requiring careful assessment and monitoring 2
- Early intervention with appropriate splinting is associated with better outcomes and prevention of contractures 6
The key to successful management is maintaining reduction while allowing early controlled motion to prevent stiffness. Extension block splinting has proven to be an effective conservative approach for most PIP joint subluxations with good initial reduction.