Management of Flexor Pulley Injuries with Proximal Interphalangeal Joint Contracture

Flexor pulley ruptures with severe proximal interphalangeal (PIP) joint contracture present a complex challenge for the hand surgeon. Four patients were treated with a delayed presentation of pulley rupture and fixed PIP flexion contracture with a technique of external extension torque application followed by splinting without pulley reconstruction. Using this technique, the PIP joint contractures improved from an average of 66° to an average of 19°, patient satisfaction was high, and the pulley injuries were managed with splinting alone without open pulley reconstruction.