BACKGROUND: The authors delineate a subgroup of proximal interphalangeal joint injuries with chronic pain and limitation of movement, despite a stable joint, and describe and evaluate a surgical procedure. METHODS: Through a volar approach, the volar plate is freed from scar but remains connected on either the ulnar or radial border. A new connection to the middle phalanx is established by creating a bony groove, and the volar plate is loosely attached distally. Fifty-four joints with chronic volar plate avulsion injuries of the proximal interphalangeal joint were evaluated. All patients had chronic pain and limitation of motion and function in a stable and congruent joint. Patients were examined at 6 weeks, 3 months, and 1 year after surgery. Range of motion, grip strength, and pain were evaluated. The average time to surgery was 10.5 +/- 11.8 months (range, 2 to 65.4 months). The mean postoperative follow-up period was 10.0 +/- 12.8 months (range, 3 to 73.5 months). RESULTS: All patients had an improved range of motion following surgery. The difference from the preoperative range of motion was statistically significant (p < 0.0001). None of the patients reported pain on rest after surgery, and five patients reported activity pain. The mean grip strength was 32.4 +/- 13.4 kg for hand that had been operated on and 41.0 +/- 14 kg for the hand that had not been operated on. CONCLUSIONS: This technique for repair of chronic volar plate avulsion injuries allows early motion and results in significant improvement in range of motion, pain, and overall function in this subgroup of patients.
BACKGROUND: The authors delineate a subgroup of proximal interphalangeal joint injuries with chronic pain and limitation of movement, despite a stable joint, and describe and evaluate a surgical procedure. METHODS: Through a volar approach, the volar plate is freed from scar but remains connected on either the ulnar or radial border. A new connection to the middle phalanx is established by creating a bony groove, and the volar plate is loosely attached distally. Fifty-four joints with chronic volar plate avulsion injuries of the proximal interphalangeal joint were evaluated. All patients had chronic pain and limitation of motion and function in a stable and congruent joint. Patients were examined at 6 weeks, 3 months, and 1 year after surgery. Range of motion, grip strength, and pain were evaluated. The average time to surgery was 10.5 +/- 11.8 months (range, 2 to 65.4 months). The mean postoperative follow-up period was 10.0 +/- 12.8 months (range, 3 to 73.5 months). RESULTS: All patients had an improved range of motion following surgery. The difference from the preoperative range of motion was statistically significant (p < 0.0001). None of the patients reported pain on rest after surgery, and five patients reported activity pain. The mean grip strength was 32.4 +/- 13.4 kg for hand that had been operated on and 41.0 +/- 14 kg for the hand that had not been operated on. CONCLUSIONS: This technique for repair of chronic volar plate avulsion injuries allows early motion and results in significant improvement in range of motion, pain, and overall function in this subgroup of patients.