Extension block splinting for the proximal interphalangeal joint.

The Americanjoumal a/Occupational Therapy T he proXimal interphalangeal (PIP) joint is particularly susceptible to acute ligamentous injury, and such an injury can result in swelling without ligament laXity, collateral ligament laXity and disruption, or a partial or complete avulsion of the volar plate with or without bony involvement. Many articles have been written about methods for treatment of injuries to this joint (Bowers, 1983; London, 1971; Lopez & Hanley, 1985; McCue, Baugher, Kulund, & Giek, 1979; McElfresh, Dobyns, & O'Brien, 1972; Moberg, 1960; Strong, 1980) Conservative treatment is the treatment of choice for many hand injuries if the goal is to return the patient to normal activities as qUickly as possible. Bowers, McCue et aI., McElfresh et aI., Moberg, and Strong have each described treatment protOcols for various injuries to the PIP joint. McCue et al. and Moberg suggested a period of static splinting followed by dynamic and protective splinting (usually buddy taping). Bowers suggested early mobilization with some form of extension block splinting for sprains (Grade I and II), lateral ligament disruption (Grade III) with articular congruity, volar capsular injuries, certain intra-articular fractures, and certain unstable unicondylar and bicondylar fractures. McElfresh et at. suggested early mobilization with extension block splinting for fracture dislocations with volar instability. Strong recommended his version of extension block splinting with volar plate avulsions not involving collateral ligament laXity. McElfresh et al. (972) used a plaster cast with an aluminum outrigger to block the PIP joint extension at an angle of about 10 0 to 15 0 Although the •