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.
When you see a PIP fracture dislocation, your first question should be stability — test it clinically after a digital block and confirm with a lateral radiograph in full extension; the percentage of articular surface involved predicts but does not replace functional stability testing.
Anatomic articular reduction is a secondary goal: correct the subluxation, restore the cup-shaped middle phalanx geometry, and get the joint moving early. Persistent fragment depression in a concentrically reduced, mobile joint reliably remodels.
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.
When you see a PIP fracture dislocation, your first question should be stability — test it clinically after a digital block and confirm with a lateral radiograph in full extension; the percentage of articular surface involved predicts but does not replace functional stability testing.
Anatomic articular reduction is a secondary goal: correct the subluxation, restore the cup-shaped middle phalanx geometry, and get the joint moving early. Persistent fragment depression in a concentrically reduced, mobile joint reliably remodels.