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Review of Treatment for PIP Flexion Contracture

Injury to the hand resulting in a flexion contracture can lead to many problems. This is especially true when the middle joint of the finger is involved. This joint is called the proximal interphalangeal joint or PIP. The PIP can get stuck in a flexed position called a flexion contracture.

In this article, two hand surgeons offer a review of the best treatment for this condition. It's an important joint because it makes movement of the fingertip possible. Without full PIP extension, it is difficult to make a fist, grasp large objects, shake hands with someone, or pull on a pair of gloves.

Early treatment is needed to help prevent a permanent loss of finger extension. Conservative care with "buddy taping," (taping the injured finger to a healthy finger) and splinting are common treatment options.

Physical therapy to restore motion early is advised. Immobilization in a cast or splint should be limited to less than three weeks. The finger should be splinted in a straight (extended) position. This will help prevent other contractures from developing.

A finger cast can be used but must be changed often. As the finger regains motion, a new cast is applied to straighten the PIP even more. Splints with springs or rubber bands called dynamic splints are an even better choice. Dynamic splinting allows both active and passive joint motion and can be removed for good hygiene.

The authors conclude it is much easier to prevent PIP flexion contractures than to successfully treat them. Splinting may take months to gain success and only with the patient's cooperation.

Surgery shouldn't be considered until conservative care has been tried for six months or more. Which operative technique to use for best results remains unclear. Many reports show a poor outcome after surgery for this problem. In a small number of cases, fusion of the joint or amputation of the finger is the only option.

References: Christopher J. Hogan, MD, and James A. Nunley, MD. Posttraumatic Proximal Interphalangeal Joint Flexion Contractures. In Journal of the American Academy of Orthopaedic Surgeons. September 2006. Vol. 14. No. 9. Pp. 524-533.

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