From the Guidelines
Avulsion fractures of the DIP joint should be managed with immobilization and splinting for 6-8 weeks, with surgical intervention considered for larger fractures or significant displacement, as indicated by the American College of Radiology guidelines 1. The management of avulsion fractures of the DIP joint involves a combination of immobilization, pain management, and rehabilitation.
- Immobilization with a splint is recommended for 6-8 weeks to allow proper healing of the bone fragment.
- For small avulsion fractures (less than one-third of the joint surface), conservative treatment is recommended with the DIP joint splinted in slight extension or neutral position 1.
- Larger avulsion fractures (involvement of more than one-third of the articular surface) or those with significant displacement, such as palmar displacement of the distal phalanx or an interfragmentary gap of >3 mm, may require surgical intervention, such as K-wire fixation or open reduction and internal fixation 1.
- Pain management includes acetaminophen or NSAIDs like ibuprofen for 5-7 days, and ice application for 15-20 minutes several times daily during the first 48-72 hours helps reduce swelling.
- After the immobilization period, gentle range-of-motion exercises should be initiated to prevent stiffness, gradually progressing to strengthening exercises. The goal of these guidelines is to promote proper healing of the bone fragment while maintaining joint stability and function, as avulsion fractures occur when a tendon pulls away a piece of bone at its attachment site, commonly affecting the extensor or flexor tendons at the DIP joint.
From the Research
Guidelines for Avulsion Fracture of the DIP Joint
- The treatment for avulsion fractures of the DIP joint depends on the severity of the fracture and the presence of subluxation or dislocation 2, 3, 4, 5.
- For mallet injuries with a small fracture fragment, continuous splinting of the DIP joint in extension for 5-6 weeks is recommended 2.
- For fracture dislocations, open reduction and internal fixation is indicated 2.
- If the fracture involves more than one-third of the articular surface of the distal phalanx, surgical fixation is recommended to prevent subluxation of the DIP joint 3.
- The risk factors for DIP joint subluxation include fracture size and time to application of a finger immobilizer, with optimal cut-off values of 48% for fracture size and 12.5 days for time to immobilizer application 3.
- Conservative treatment options include casting or splinting with a period of immobilization, while surgical options include screw fixation, closed reduction and percutaneous pinning, and open reduction and internal fixation 4, 5.
- The choice of treatment depends on the severity of the fracture, patient demographics, and surgeon preference, with no clear consensus on the best treatment option 4, 5.