Quick splint for acute boutonniére injuries

Simultaneous Central Slip and Volar Plate Injuries at PIP Joint: A Novel Therapeutic Approach

Background:

Central slip and volar plate injuries rarely occur in the same finger, with only two cases previously reported in published literature. In these two patients, both teenagers, two highly distinct protocols were used. Here, we report a third case involving a 51-year-old gentleman who closed a door on his left third finger.

Methods:

Because the fractures were noncomminuted and only minimally displaced, he was treated nonsurgically using a multi-step process of splinting to prevent impairment of either proximal interphalangeal joint extension or flexion, combined with active range of motion exercises. This included five weeks of splinting in neutral, 24-hour daily use of a proximal interphalangeal dorsal block, followed by active range of motion exercises combined with nocturnal splinting using a PIP volar block over the next 7 weeks, with relative motion and Joint Jack splints added over the final 4 of these 7 weeks.

Results:

Twelve weeks after initial splinting, the patient’s finger was pain free, with swelling largely resolved, normal extension (−10 degrees) and near-normal flexion (95 degrees) achieved, and full function restored. The patient was very satisfied with the result.

Conclusions:

Ours is just the third case of concomitant central slip and volar plate injuries reported in the literature. Other surgeons are strongly encouraged to publish similar cases, approaches, and results, as clinical wisdom can sometimes be gleaned from even a small number of well-documented clinical cases.