Volar lip fractures with dorsal subluxation are caused by hyperextension or axial load injury. Prompt diagnosis and recognition of injury severity correlates with outcomes, where proper treatment aims to achieve and maintain well-reduced stable joint, restore normal joint kinematics, and preserve motions. Though conservative management with buddy taping or splint result in satisfactory result in stable pathologies, unstable fractures with displacement and/or compromised extensor mechanism mostly requires surgical management.

This article presents a case of 65-years-old male with chief complaint of painful left little finger since 3 months prior to admission. He also complained stiffness on his left little finger. This complaint restricts his fine movement for daily activities. From the anamnesis, it was revealed that there was a history of trauma, when he was riding a motorcycle 3 months ago, suddenly slipped and fell down with his left little finger bumped to the ground. He had a past history of rheumatoid hand, but never seek treatment. From physical examination, limited range of motion was seen on the left little finger, especially on the Proximal Interphalangeal Joint. The range of movement on metacarpophalangeal joint of the little finger was 30o in extension and 90o in flexion. Plain X-Ray revealed dorsal fracture dislocation (volar lip) of proximal interphalangeal joint of left little finger.

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Figure 1. Physical examination revealing restricted range of motion over PIP joint

Figure 2. X-Ray of left little finger in accordance with volar lip fracture on PIP joint

A surgery was then performed using volar approach on the PIP Joint. Hemihamate reconstruction was also performed, where it is one of the most recently developed technique for volar buttress reconstruction. Autograft was harvested from the dorsal distal hamate between 4th and 5th metacarpals, afterwards three compression screws were applied to fix the autograft on the base of middle phalanx. Immediate stability was observed in our patient, and long-term result was satisfactory according to recent literatures.

Figure 3. Volar approach to PIP joint of little finger step by step, exposing fracture dislocation.

Figure 4. Harvesting of hemihamate bone graft

Figure 5. Reconstruction, bone graft insertion, and fixation with 3 mini-screws over middle phalanx.

Figure 6. Intraoperative C-Arm imaging of open reduction and internal fixation (initially with K-Wire, followed by mini-screws as definitive fixation).

In addition, post-operative rehabilitation plays an important role in the management of this injury. Active ROM exercise within the stable range should begin as soon as possible, and immobilization should not be retained for more than 4 weeks, as it might result in permanent loss of motion. Some authors advised against passive ROM exercise immediately in postoperative period as it might place stress on soft tissue and compromise bone healing.

Though a common finger injury, the management of volar lip fractures is challenging and the choice of treatment should always be based on each patient’s characteristics, in terms of social activity, dominant hand, and fracture stability.