Treatment of Dorsal Fracture/Dislocations of the Proximal Interphalangeal Joint by Volar Plate Arthroplasty

Current Concepts in Treatment of Fracture-Dislocations of the Proximal Interphalangeal Joint

“…Indications for volar plate arthroplasty include acute fracture-dislocations where a stable volar lip cannot be satisfactorily reconstructed with other means, or in chronic injuries where the joint is not yet arthritic. 53 In one of the longest follow-up studies (11.5 years), Dionysian and Eaton showed that in cases of acute injury, arc of motion of 85° was maintained over time, with average extension lag of 15°. In the subset of chronic cases, arc of motion was only 61° and extension lag was 29°.…”

Biomechanical Characteristics of Hemi-Hamate Reconstruction Versus Volar Plate Arthroplasty in the Treatment of Dorsal Fracture Dislocations of the Proximal Interphalangeal Joint

“…Indeed, in clinical studies, authors have reported final mean flexion contractures after VPA of 10 to 30 . 7,13,17,18 Our study simply reported the flexion contracture when using VPA for each size palmar middle phalanx defect and demonstrated a linear relationship between defect size and flexion contracture, which was likely a result of advancement of the volar plate and fixation into the bony defect and not physiologic shortening of the soft tissue surrounding the joint. Conversely, in the HHA group the volar plate was not repaired, which could have contributed to the lack of any flexion contractures in this testing scenario.…”

Injuries Around the Proximal Interphalangeal Joint

“…The volar plate is incised along its most lateral (from the collaterals) and distal margins (from the base of the middle phalanx), creating a flap that is as broad and long as possible. 79 The volar plate is attached to the most dorsal part of the articular defect after fashioning of a trough. This trough should be perpendicular to the long axis of the middle phalanx to prevent angular deformity and asymmetric collapse.…”

“…Complications include angular deformities, 18,79,80 flexion contracture of PIPJ and distal interphalangeal joint (DIPJ), 4,80 pin and wire tract infections, redisplacement, and recurrent subluxation. 4,9,80 VPA has a tendency for flexion deformity, which increases with an increasing defect in the middle phalanx palmar base as the volar plate is advanced further into the joint.…”