This 2009 Current Concepts review by Calfee and Sommerkamp surveys treatment options and outcomes for fracture-dislocations at the PIP, DIP, and MCP joints of the fingers. It addresses how fracture pattern, articular surface involvement, joint stability, and injury chronicity should drive treatment selection at each joint level.
When evaluating a finger fracture-dislocation, lead with the lateral radiograph to quantify articular surface involvement and check for the dorsal 'V' sign of subtle PIP instability — this single measurement drives the entire treatment algorithm.
For DIP bony mallets with subluxation, counsel patients that nonsurgical splinting is a legitimate option given the high surgical complication rate, but persistent subluxation risks worse cosmesis and extensor lag.
This 2009 Current Concepts review by Calfee and Sommerkamp surveys treatment options and outcomes for fracture-dislocations at the PIP, DIP, and MCP joints of the fingers. It addresses how fracture pattern, articular surface involvement, joint stability, and injury chronicity should drive treatment selection at each joint level.
When evaluating a finger fracture-dislocation, lead with the lateral radiograph to quantify articular surface involvement and check for the dorsal 'V' sign of subtle PIP instability — this single measurement drives the entire treatment algorithm.
For DIP bony mallets with subluxation, counsel patients that nonsurgical splinting is a legitimate option given the high surgical complication rate, but persistent subluxation risks worse cosmesis and extensor lag.