Reconstructive and salvage techniques for proximal interphalangeal joint fracture dislocations

Proximal interphalangeal joint (PIPJ) fracture dislocations are frequently injured during sports, and often present in a delayed fashion. Untimely management may lead to recurrent subluxation and chronic stiffness, arthrosis, and pain.¹ Unstable injuries frequently require surgical management with either internal or external fixation to maintain articular reduction and allow early mobilization. Delay in presentation or extensive fracture comminution presents technical challenges and may necessitate a reconstructive or salvage procedure. We have defined reconstructive procedures as those that restore the articular surface using an osteochondral graft, and salvage procedures as those that do not involve restoring the articular surface. Various reconstructive techniques have been reported and popularised, including; hemi hamate arthroplasty, hemi capitate arthroplasty, full height hamate arthroplasty and toe osteochondral graft. Similarly, salvage techniques described include volar plate arthroplasty, implant arthroplasty and arthrodesis. In this review, we present the surgical options available to hand surgeons, and a suggested algorithm to assist management of PIPJ fracture dislocations that require either a reconstructive or salvage procedure.