Volar (palmar) lip fracture of the base of the middle phalanx

Volar (ie, palmar) lip fractures are the most common type of fracture of the base of the middle phalanx and result from a combination of proximal interphalangeal (PIP) joint hyperextension and axial loading. Patients present with swelling, pain, limited motion at the PIP joint, and a flexed finger posture. The radiograph shows a dorsal subluxation of the PIP joint, noted by the V-sign, in addition to a lip fracture involving greater than 50 percent of the articular surface.