Case report: Open reduction and extension block pinning with volar plate reconstruction for 1 month PIP joint dislocation

Abstract

Proximal interphalangeal (PIP) fracture-dislocation is a common injury that results from “jamming” a finger. It can be classified according to displacement of proximal phalanx over middle phalanx. For simple dislocation treatment can be closed reduction and splinting. For old cases open reduction is usually required. Following open reduction stability of the joint is checked and accordingly augmentation of stability is done. For unstable injuries, a variety of surgical interventions have been described including extension block pinning, open reduction internal fixation, volar plate arthroplasty, static or dynamic external fixation, and hemi-hamate reconstruction. For fracture dislocation treatment varies with the degree of articular surface involvement, which determines stability of the joint. We present the case of an unstable, subacute middle finger PIP dorsal fracture dislocation in a young female for which attempts of closed reduction were given elsewhere but it could not be reduced. With volar approach we reduced the joint and for augmentation of the stability we did volar plate reconstruction using z-plasty of A3 pully. For additional stability we did extension block pinning.