Management of PIP Dislocation with Avulsion Fracture: Buddy Taping vs. Splinting
Buddy taping is appropriate for stable PIP joint dislocations with avulsion fractures, as it provides adequate stabilization while allowing early range of motion to prevent stiffness. 1
Assessment and Classification
- PIP joint dislocations with avulsion fractures should be evaluated for stability, displacement, and joint congruity to determine the optimal treatment approach 2
- Stable injuries with minimal displacement are suitable for conservative management with buddy taping 1
- Unstable injuries with significant displacement (>3mm), dorsal tilt (>10°), or substantial intraarticular involvement require more rigid immobilization or surgical intervention 2
Treatment Recommendations
For Stable PIP Dislocations with Avulsion Fracture:
- Buddy taping (taping the injured finger to an adjacent finger) during the day combined with a straight finger splint at night for approximately 3 weeks is an effective treatment approach 1
- This approach allows for protected early motion, which helps prevent stiffness while maintaining adequate stability 1
- Studies show no significant difference in outcomes (pain, range of motion, edema) between PIP volar plate injuries with or without avulsion fractures when treated with buddy taping 1
For Unstable PIP Dislocations:
- Rigid immobilization with splinting is preferred for unstable injuries with significant displacement 2
- Do not attempt to straighten or realign an angulated fracture-dislocation in the first aid setting, as this may cause further injury 3
- Splint in the position found if immediate medical care is not available 3
Rehabilitation Considerations
- Active finger motion exercises should be performed as soon as stability allows to prevent stiffness, which is one of the most functionally disabling adverse effects 3
- Early protected motion with buddy taping helps maintain joint mobility while the injury heals 1
- Finger stiffness can be very difficult to treat after healing, potentially requiring multiple therapy visits and additional surgical intervention 3
Potential Complications and Pitfalls
- Prolonged rigid immobilization beyond what is necessary can lead to joint stiffness and decreased function 3
- Inadequate stabilization of unstable injuries can result in malunion, joint incongruity, and subsequent arthritis 2
- Complex fracture-dislocations with significant articular involvement may require surgical intervention rather than conservative management 4
- For dorsolateral dislocations, anatomical studies show that closed reduction typically returns the avulsed palmar plate and collateral ligaments to their anatomic positions, supporting the use of functional treatment like buddy taping 5
Follow-up Recommendations
- Regular radiographic follow-up is recommended at approximately 3 weeks and at the time of immobilization removal to confirm adequate healing 6
- If pain persists or range of motion deteriorates, reevaluation is warranted to rule out complications 7
In conclusion, buddy taping is an appropriate and effective treatment for stable PIP dislocations with avulsion fractures, as it provides adequate stability while allowing early protected motion to prevent stiffness and optimize functional outcomes 1.