1. Palmar lip # lead to Dorsal sublaxation - volar plate impaction
   1. stability of reduction & percent of #
      1. stable & less than 30% #
         1. stable in extension
            1. Rx. allow full flexion & preventing hyperextension = figure of 8 splint
         2. Stable in Hyper-extension Swan neck deformity
      2. tenuous=weak & Thin & 30-50%#
         1. stable if PIP is flexed at less than 30 degree
            1. I. Extension block splint allowing maximum extension with full stability for 3/52, then increase 10degrees every week until full extensiona & Stability is possible at 6-8/52
      3. Unstable & more than 50%
         1. stable if PIP is flexed MORE than 30 degree
            1. big fragment
            2. Rx. K wire or screw
            3. comminuted
            4. II. Rx. if stable with traction: traction devices eg. Suzuki
            5. II. Rx. untable with traction: Palmar plate artheroplasty
2. Dorsal lip # lead to palmar sublaxation - Central slip impaction - stability is Always assessed in extension
   1. STABLE in PIP extension
      1. gap 2mm or less - splint immobilization of PIP in extension for 1/12
      2. more than 2mm gap- ORIF with immediate mobilization post op
   2. UNstable = volar Sublaxation
      1. big fragment
      2. comminuted
         1. central tendon repair & ORIF to restor cup shape & Immobilize for 1/12
         2. if can NOT restore cup shape and stability - Rx: bone grafting
3. pilon= volar & dorsal lip fracture - volar plate and central slip impaction
   1. General rules for all PIP # & Dislo. Treatment = 1st Stability AND 2nd early motion +/- 3ed anatomical reconstruction
      1. I .1st: Traction with early motion for 6/52 +/- limited open reduction with wires, 2nd : aggressive ROM started after traction