PIPJ Volar Plate Avulsion Injury

I suffered a sporting injury to my right index finger 5 weeks ago, it was direct blow to the end of the finger causing a tuft fracture  right at the tip, a fracture lower on the distal phalanx near the DIP joint, tendon damage, causing a mallet deformity, along with a Volar Plate avulsion fracture of the PIP joint (bottom corner of the middle phalanx). Intitally I was given a straight splint to wear, which caused the PIP point to become very stiff, leading me to take advice from another doctor after a week, who commented that the PIP joint was subluxed, and wanted me to get it moving, which I have over the last 4 weeks, and I can get it to about 75 deg unaided, and 90 deg aided to the point it feels that that is as far as the joint will move, this is done so with a great deal of clicking,popping (sometimes painful) and grating sensation in the joint. With this movement the 2nd doctor said i didnt need to see him again. I am however concerned that all of this clicking popping in the joint is causing damage and that on external inspection its obvoius the joint is still subluxing as the top of the middle phalanx sits a lot higher than the Proximal one when held straight. Will this subluxing self correct? and what would be the cause of all of the joint clicking, popping and grating?

[S. Kaul, MD]

Hi there!

The subluxation is unlikely to correct by itself. The initial splint was the correct management at the time and would have been needed for about 2-4 weeks depending on the degree of the injury. Stiffness is a side effect of immobility which is usually dealt with later with physical therapy. Though subluxation may cause restricted movement, movement does not correct subluxation; which would have required reduction and brief splinting/ buddy taping or extension block casting; while surgery is considered in severe cases. It would be difficult to comment on the current situation without an evaluation. My best advice at this time would be to seek an opinion with another orthopedician to get his/ her views on appropriate management.
Hope this was helpful.

Take care!