Palmar dislocation of the proximal interphalangeal joint

Fifteen patients with palmar dislocations of the proximal interphalangeal (PIP) joint were reviewed 6 to 49 months after treatment (average 17.8 months). Disruption of the extensor mechanism, palmar plate, and one collateral ligament was found in all patients. The loss of static and dynamic joint support caused palmar subluxation, malrotation, and a boutonnière deformity. Two dislocations were irreducible, and three were associated with dorsal avulsion fractures from the middle phalanx. The serious nature of the injuries from this dislocation was initially unrecognized, and most patients were casually treated; delay from injury to referral averaged more than 11 weeks. Twelve of the 15 required surgery for joint reduction and tendon and ligament repair; three treated earlier were managed by closed reduction and percutaneous pinning. Joint alignment, comfort, and stability were restored, and all returned to full activities including heavy labor. However, a full range of PIP motion was not recovered in any case.