Kiefhaber, J Hand Surg Am 1998 - Fracture Dislocations of the Proximal Interphalangeal Joint

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Fracture Dislocations of the Proximal Interphalangeal Joint

Kiefhaber, Stern·J Hand Surg Am·1998·194 citations·Review article

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Kiefhaber and Stern present a stability-based classification and treatment algorithm for PIP joint fracture dislocations, addressing three fracture patterns — palmar lip, dorsal lip, and pilon — and asking which injuries require anatomic articular reduction, joint reduction, and early motion to achieve acceptable outcomes.

Key Findings

Stability-based classification divides palmar lip fractures into stable (<30% articular surface, reduces in extension), tenuous (30–50%, reduces with ≤30° flexion), and unstable (>50%, or 30–50% requiring >30° flexion) — treatment is matched to each tier
Joint reduction is mandatory: persistent dorsal subluxation prevents normal middle phalangeal glide and is consistently associated with poor outcomes across multiple cited series
Anatomic articular surface reduction is NOT required. Traction with early motion outperformed both splinting and ORIF for pilon fractures (4/4 splinted had major pain; 7/9 ORIF had persistent pain; 4/7 traction were pain-free with no reoperations)
For stable palmar lip fractures, 68% showed fragment displacement and 30% went on to nonunion, yet excessive immobilization, not the fracture itself, was the only predictor of poor outcome
Palmar plate arthroplasty is the authors' preferred treatment for unstable palmar lip fractures, reconstructing the middle phalanx palmar buttress and restoring palmar plate continuity in a single procedure

Fracture Dislocations of the Proximal Interphalangeal Joint.

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Fracture Dislocations of the Proximal Interphalangeal Joint

Kiefhaber, Stern·J Hand Surg Am·1998·194 citations·Review article

|

Kiefhaber and Stern present a stability-based classification and treatment algorithm for PIP joint fracture dislocations, addressing three fracture patterns — palmar lip, dorsal lip, and pilon — and asking which injuries require anatomic articular reduction, joint reduction, and early motion to achieve acceptable outcomes.

Key Findings

Stability-based classification divides palmar lip fractures into stable (<30% articular surface, reduces in extension), tenuous (30–50%, reduces with ≤30° flexion), and unstable (>50%, or 30–50% requiring >30° flexion) — treatment is matched to each tier
Joint reduction is mandatory: persistent dorsal subluxation prevents normal middle phalangeal glide and is consistently associated with poor outcomes across multiple cited series
Anatomic articular surface reduction is NOT required. Traction with early motion outperformed both splinting and ORIF for pilon fractures (4/4 splinted had major pain; 7/9 ORIF had persistent pain; 4/7 traction were pain-free with no reoperations)
For stable palmar lip fractures, 68% showed fragment displacement and 30% went on to nonunion, yet excessive immobilization, not the fracture itself, was the only predictor of poor outcome
Palmar plate arthroplasty is the authors' preferred treatment for unstable palmar lip fractures, reconstructing the middle phalanx palmar buttress and restoring palmar plate continuity in a single procedure

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