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Volar A1 pulley sparing technique for fixation of avulsion fractures of the base of the proximal phalanx

Abstract For open reduction and internal fixation of the displaced avulsion fractures of the base of the proximal phalanx of the fingers, the volar A1 pulley approach was introduced instead of the dorsal approach. Although this procedure is quite useful, the A1 pulley and volar plate need to be divided. As a less invasive alternative, the authors developed the volar A1 pulley sparing technique and treated six patients with the median follow-up period of 14 months. All fractures healed without displacement, and all patients regained full range of motion without any evidence of instability. The volar A1 pulley sparing technique is minimally invasive and provides good visualization of the fracture site without damage to the metacarpophalangeal joint and flexor tendon structure.