The PIP joint is the most complex and injury-prone small joint in the body. It is stabilised by the volar plate, the radial and ulnar collateral ligaments (taut throughout the range unlike MCP joints), and the central slip of the extensor tendon. PIP joint injuries produce the most common ligamentous hand injury — most finger sprains involve the PIP collateral ligaments or volar plate.
PIP joint dorsal dislocations are reduced by traction and flexion then splinted in 30 degrees of flexion. Volar plate avulsions are managed with extension block splinting. Fracture-dislocations (volar lip fractures >40% of joint surface) require dynamic external fixation or ORIF. The key principle: avoid rigid immobilisation of PIP joints which develop fixed contractures within weeks of immobilisation.
Dorsal PIP joint dislocation producing hyperextension deformity reduced with traction-flexion and managed with buddy taping allowing early motion.
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