Chapter 21 Volar Plate Arthroplasty
Surgical Overview
• Volar plate arthroplasty is a surgical technique used to treat unstable dorsal fracture dislocations of the PIP with disruption of the volar plate complex, the collateral ligaments, and greater than 40% of the volar articular surface of the middle phalanx.
• The volar plate is mobilized to advance 4 to 6 mm into the middle phalanx defect.
1 The plate is advanced by means of a pullout wire along the lateral margins of the volar plate and then exits the dorsal middle phalanx through the triangular ligament of the extensor mechanism.
• A longitudinal K-wire or PIP compass hinge may be used to maintain the reduced joint in 30-degree flexion in severely unstable fractures (see chapter on PIP compass hinge).
Rehabilitation Overview
• Because this is a complex injury that requires postoperative protection, it is often difficult to achieve adequate PIP range of motion (ROM).
• It is essential that postoperative management by the hand therapist begins in the early phases of wound healing.
• To avoid complications, such as contraction of the scarred volar plate and flexor tendons, protected motion must be initiated as early as possible.
• The PIP joint is particularly prone to adhesions and contractures because multiple structures cross the joint. The structures include collateral ligaments, volar plate, central slip, lateral bands, transverse retinacular ligaments, oblique retinacular ligament, and flexor tendons.
