Executive Editor: Chris Colton

Authors: Fiesky Nuñez, Renato Fricker, Matej Kastelec, Terry Axelrod

Middle phalanx - PIP joint - dorsal avulsion fracture

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Aftertreatment depends on the size of the fragment, the quality of the bone, and the stability gained by the fixation.

The PIP joint is immobilized in extension in a palmar splint, leaving the DIP joint free.
DIP joint movement is encouraged immediately to avoid extensor tendon adhesion.
If the fixation is strong enough, the patient is encouraged to take off the splint 2-3 times daily, and to commence with gentle active exercises.
Use of a night splint is recommended for a duration of 6-8 weeks.

Functional exercises
After 3 weeks, the splint is removed, and unrestricted active flexion and extension is permitted.
Passive motion is only permitted after 4 weeks.

Implant removal
The implants need to be removed in case of soft-tissue irritation.
In case of stiffness or tendon adhesion restricting finger movement, tenolysis, capsulolysis, and joint mobilization during surgery are necessary. In these circumstances, take the opportunity to remove implants.

v1.0 2008-11-08