From the Guidelines
Surgery is the usual treatment for a pip avulsion fracture, but simple immobilization is appropriate when fracture fragments are small, nonarticular, or minimally displaced. A pip avulsion fracture occurs when a small piece of bone is pulled away from the main bone by a tendon or ligament at the proximal interphalangeal joint. The diagnosis is based on a history of trauma and focal pain on palpation, and is confirmed with radiographic studies 1.
Key Considerations
- The size and displacement of the fracture are crucial in determining the treatment approach
- Conservative management may be suitable for small, non-displaced fractures, but surgical intervention may be necessary for larger fragments or displaced fractures
- Early protected range of motion exercises are essential to prevent stiffness and promote healing
- Follow-up with a specialist is necessary to reassess and adjust the treatment plan as needed
Treatment Options
- Simple immobilization for small, nonarticular, or minimally displaced fractures
- Surgical intervention, including pin fixation or screw fixation, for larger fragments or displaced fractures
- Conservative management with buddy taping, ice, and over-the-counter pain medications for small, non-displaced fractures
- Early protected range of motion exercises to prevent stiffness and promote healing, as recommended by the american college of foot and ankle surgeons: diagnosis and treatment of heel pain 1.
From the Research
Definition and Treatment of Pip Avulsion Fracture
- A pip avulsion fracture is a type of injury that occurs at the proximal interphalangeal (PIP) joint, where a fragment of bone is pulled off by a ligament or tendon 2.
- The treatment of pip avulsion fractures can be conservative or surgical, depending on the severity of the injury and the presence of other complications 3, 4.
Conservative Treatment
- Conservative treatment of pip avulsion fractures typically involves buddy taping and immobilization in a splint, followed by early mobilization and rehabilitation 2, 5.
- Studies have shown that conservative treatment can be effective in treating pip avulsion fractures, with good outcomes in terms of pain, range of motion, and edema 2.
Surgical Treatment
- Surgical treatment of pip avulsion fractures may be necessary in cases where the fracture is unstable or there are other complications, such as ligament or tendon injuries 3, 4, 6.
- Surgical options include open reduction and internal fixation, volar plate arthroplasty, and hemi-hamate arthroplasty, among others 3.
- A percutaneous technique has also been described, which involves closed reduction and percutaneous pinning via a volar approach, with good short-term outcomes 6.
Outcomes and Complications
- The outcomes of pip avulsion fractures depend on the severity of the injury and the effectiveness of treatment, with potential complications including chronic pain, stiffness, and arthritis 3, 4, 5.
- Early functional treatment and rehabilitation are important to restore PIP joint movement and function, and to prevent long-term complications 5.