How should a dorsal proximal interphalangeal (PIP) joint dislocation be splinted?

Splinting a Dorsal PIP Joint Dislocation

After closed reduction of a stable dorsal PIP joint dislocation, apply a dorsal blocking splint that prevents the last 20-30 degrees of extension while allowing full flexion, and begin immediate active flexion exercises within the protected range. 1, 2

Immediate Post-Reduction Splinting Technique

• Position the PIP joint in 10-30 degrees of flexion using a dorsal blocking splint that prevents hyperextension but permits active flexion 1, 3
• The splint must block only extension beyond the safe range—do not immobilize the joint rigidly in a fixed position 2, 4
• Leave the DIP joint completely free to move, as immobilizing unaffected joints causes unnecessary stiffness 2
• After closed reduction, the avulsed volar plate and collateral ligaments return to their anatomic positions at 10 degrees of flexion, which is why this position is protective 3

Critical Early Motion Protocol

• Begin active flexion exercises immediately within the first 24-48 hours while the dorsal block is in place—this is the single most important intervention to prevent stiffness 2, 4
• Instruct the patient to actively flex the PIP joint to full flexion multiple times daily while the splint prevents terminal extension 2, 5
• Active motion does not adversely affect stable reductions and dramatically reduces the risk of permanent joint contracture 2

Splinting Duration

• Maintain the dorsal blocking splint for 3-6 weeks maximum for stable injuries without significant fracture fragments 1, 2
• Progressively reduce the extension block by 10-15 degrees each week as healing progresses, gradually allowing more extension 5, 4
• By week 3-4, most patients can transition to buddy taping to the adjacent finger for an additional 2-3 weeks 4

When Rigid Immobilization Is Required

• Use rigid (non-removable) immobilization only if there is:
  • Displacement >3mm 1
  • Dorsal tilt >10° 1
  • Volar lip fracture involving >30-40% of the articular surface 1, 6
  • Joint instability or subluxation after reduction 1
• Even with rigid splinting for unstable injuries, begin protected motion as soon as stability allows, typically by 2-3 weeks 2, 6

Radiographic Follow-Up

• Obtain repeat radiographs at 10-14 days to confirm maintained reduction 1
• Repeat imaging at 3 weeks and at the end of immobilization 1, 2
• If the joint redislocates or subluxes on follow-up films, refer immediately for surgical evaluation 1, 6

Critical Pitfalls to Avoid

• Never splint in full extension—this places maximum tension on the healing volar structures and promotes redislocation 5, 3
• Do not over-immobilize beyond 6 weeks—prolonged rigid splinting is the leading cause of permanent PIP joint stiffness, which is extremely difficult to treat and may require multiple therapy visits or additional surgery 2, 4
• Do not immobilize adjacent fingers unless buddy taping for late-stage protection 2
• Do not attempt reduction in the field if there is obvious deformity suggesting fracture-dislocation—splint in position found and refer emergently 1

Indications for Immediate Surgical Referral

• Irreducible dislocation after closed reduction attempt 4, 6
• Volar lip fracture >30-40% of articular surface 6, 3
• Persistent joint subluxation or incongruity after reduction 1, 6
• Open dislocation 5
• Fracture displacement >3mm, dorsal tilt >10°, or intra-articular gap >3mm 1