A new technique for late PIP joint volar plate reconstruction: Description of the technique and outcomes in 12 patients with a mean follow-up of seven years.

BACKGROUND: The volar plate (VP) of the proximal interphalangeal joint (PIPj) is a key stabilizer against postero-anterior stresses. Traumatic VP disruption typically results from PIPj hyperextension combined with variable degrees of lateral deviation or torsional forces. Missed diagnoses and inadequate early management, particularly in patients with rheumatic conditions, may lead to chronic lesions and progressive PIPj hyperextension deformities. This study describes a novel surgical technique for chronic volar plate reconstruction and evaluates its long-term clinical outcomes.

MATERIALS AND METHODS: The technique consists of creating a check-rein mechanism over the PIPj using two distally based tendon slips of the flexor digitorum superficialis (FDS). These slips are crossed over the joint and secured with two mini bone anchors implanted in the proximal phalanx metaphysis. Twelve digits with chronic traumatic VP disruption were treated at two institutions and retrospectively reviewed. The mean follow-up period was 7 years. Outcomes were assessed using Catalano's criteria (excellent, good, fair, poor). Range of motion (ROM) of the PIPj and DIPj was recorded preoperatively and at final evaluation. Patients completed the DASH questionnaire, and pain was assessed using a numeric rating scale (NRS).

RESULTS: At the latest follow-up, outcomes were classified as excellent in 8 cases, good in 3 cases, and fair in 1 case, the latter due to postoperative PIPj contracture. No failures of the reconstruction and no recurrence of the initial deformity were observed. Eleven of twelve patients returned to their previous occupational activities, including those requiring high functional demands such as competitive sports.

CONCLUSION: This technique provides a straightforward surgical option for correcting chronic PIPj hyperextension deformities, with durable and satisfactory outcomes at long-term follow-up. Larger samples and comparative studies are required to further validate its effectiveness and potential advantages over existing reconstructive methods.