A Novel Palmar Approach for Arthroplasty of the Distal Interphalangeal Joint

Degenerative changes of the distal interphalangeal (DIP) joint are often managed surgically with arthrodesis or silicone implant arthroplasty when conservative treatments fail. Conventional approaches for silicone implant arthroplasty require division of the extensor tendon, leading to prolonged immobilisation and potential extension lag. We introduce a novel palmar flexor tendon splitting approach. This approach allows silicone implant arthroplasty while preserving the extensor mechanism, eliminating the need for post-surgical immobilisation and permitting early range of motion exercise. We performed silicone implant arthroplasty using this approach on 16 fingers in 12 patients and followed up for more than 3 months. There was no flexor tendon rupture or nerve injury, and the mean DIP range of motion was 28.3°, with an extension lag of 11°. Postoperative wound healing was excellent in this approach, with no delayed healing or maceration. This approach is simple and eliminates postoperative immobilisation and has the potential to reduce extension lag. Level of Evidence: Level V (Therapeutic).