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Neglected dislocation of the proximal interphalangeal joint of the Hand without fracture: A systematic review and
J Terrence Jose Jerome1,2, Ganesan Surendran3, Thirumagal Kuppusamy2
1Department of Orthopedics, Dhanalakshmi Srinivasan Medical College and Hospital, Perambalur, India.
Background:
Neglected proximal interphalangeal (PIP) joint dislocations of the Hand are uncommon and clinically challenging because chronic soft-tissue contracture and intra-articular interposition, particularly the volar plate and/or flexor mechanism, frequently prevent successful closed reduction and predispose to stiffness and persistent deformity. Evidence to guide operative management remains limited.
Methods:
A PRISMA 2020-compliant systematic review and meta-analysis was performed. A prospective protocol was registered in PROSPERO (CRD420261347690). Searches from database inception to 20 March 2026 were conducted in PubMed/MEDLINE, Cochrane CENTRAL, and Google Scholar, supplemented by backward and forward citation-chaining. Studies reporting operative treatment of neglected PIP dislocation of the Hand without fracture, defined a priori as ≥4 weeks from injury to definitive operative treatment, were eligible. Risk of bias was assessed using ROBINS-I and certainty of evidence using GRADE. Where feasible, quantitative synthesis was performed and considered exploratory. When studies did not report dispersion for range of motion (ROM), variance was imputed using conservative range-based methods.
Results:
Five studies were included in the dislocation-only review dataset, comprising two case series (n = 14 digits) and three case reports/small series (n = 4 digits). Two sources (n = 9 digits) provided extractable postoperative PIP range of motion (ROM) and were included in an exploratory random-effects synthesis, suggesting approximately 60° arc of motion. This estimate is hypothesis-generating and should not be interpreted as precise or reproducible given the extremely limited dataset. Complications were extractable from one case series only (2/7 minor events; estimated proportion 0.29; 95% CI, 0.08-0.64). Pain and functional outcomes were inconsistently reported and not amenable to pooling. Overall risk of bias was serious-to-critical, and certainty of evidence was very low for all outcomes.
Conclusions:
Operative reduction and stabilisation for neglected PIP dislocation of the Hand without fracture appears capable of restoring joint congruity and achieving a functional arc of motion, but the evidence base is sparse and methodologically weak.
