Volar plate repair for posttraumatic hyperextension deformity of the proximal interphalangeal joint

Traditionally, flexor digitorum superficialis tenodesis has been recommended for surgical correction of posttraumatic proximal interphalangeal (PIP) joint hyperextension deformity resulting from recurrent volar plate (VP) disruption. In contrast, VP repair has been used sparingly to restore joint stability, because of concerns regarding excessive scarring, insufficient substance, and the often long time between injury and repair. In the study reported here, we critically evaluated the long-term functional outcome of isolated VP repairs for chronic dorsal instability of the PIP joint performed over an 18-year period. Twenty-five patients underwent surgery for hyperextension deformity of the PIP joint. Mean time from injury to repair was 8.2 years. All patients complained of painful locking of the PIP joint in extension. Precise repair of the VP was performed by meticulous scar lysis and advancement to the anatomical site of insertion while avoiding the adjacent nutrient vessels. Follow-up evaluation included completion of the DASH (Disabilities of the Arm, Shoulder, and Hand) questionnaire and digital mobility, strength, and radiographic assessment. At a mean follow-up of 8 years, we found consistent alleviation of pain, restoration of joint stability, mean arc of motion ranging from 6 degrees to 92 degrees of flexion, and grip strength returned to within 90% of the contralateral side. All patients returned to unrestricted activities.