Treatment of Intraarticular DIP Joint Fracture of the Thumb
For intraarticular DIP joint fractures of the thumb, treatment depends on fracture displacement and comminution: nondisplaced or minimally displaced fractures should be treated with immobilization and early mobilization, while displaced fractures (>3mm displacement or >10° angulation) or comminuted intraarticular fractures require surgical intervention with either open reduction and internal fixation using K-wires or dynamic external fixation.
Treatment Algorithm
Nondisplaced or Minimally Displaced Fractures
- Conservative management with immobilization is appropriate for stable, minimally displaced intraarticular fractures 1
- Use removable splints for immobilization, which allows for early active motion exercises 2
- Initiate active finger motion exercises immediately to prevent stiffness, which is one of the most functionally disabling complications and does not adversely affect adequately stabilized fractures 2, 1
- Obtain radiographic follow-up at approximately 3 weeks and at the time of immobilization removal to confirm adequate healing 2, 1
Displaced or Comminuted Intraarticular Fractures
Surgical intervention is indicated when:
- Post-reduction displacement >3mm 1, 3
- Dorsal tilt >10° 1, 3
- Significant intra-articular involvement with comminution 3
Surgical Options:
Open Reduction and Internal Fixation (ORIF) with K-wires
- For fractures involving one-third or more of the articular surface, open reduction and internal fixation with Kirschner wires achieves excellent outcomes with average loss of extension of only 2° and average arc of flexion of 69° 4
- This technique results in essentially normal radiographic appearance in the majority of cases and equal pinch strength compared to the contralateral digit 4
- Exact anatomic reduction and rigid internal fixation are critical for optimal motion and function 4
Dynamic External Fixation
- For comminuted intraarticular fractures, dynamic external fixation with joint distraction allows early mobilization while maintaining reduction 5, 6, 7
- The pins and rubber traction system (PRTS) achieves 80% range of motion compared to the non-injured side with minimal extension deficits (median 10°) 7
- This technique is particularly useful when anatomic reduction is difficult to achieve, as it allows for joint remodeling through early mobilization 6, 7
- External fixation is typically maintained for 4 weeks, with return to full function at 7-8 weeks 6
- Average range of motion achieved is 61-64° with good subjective outcomes 5, 7
Important Clinical Considerations
- Monitor for complications including pin site infections (treatable with antibiotics), skin irritation, and muscle atrophy, which occur in approximately 14.7% of immobilization cases 1, 5
- Conservative management is not recommended for significantly displaced or comminuted intraarticular fractures due to risk of joint incongruity and subsequent arthritis 3
- While anatomic reduction is the goal, functional outcomes with dynamic external fixation remain good even when perfect anatomic reduction is not achieved, as early mobilization promotes joint remodeling 5, 6
Salvage Option
- Arthrodesis of the DIP joint is reserved for failed primary treatment or severe post-traumatic arthritis, using intramedullary implants with mean healing time of 9.1 weeks and significant pain relief 8