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Pullout suture using polyamide monofilaments for volar plate avulsion fractures of the proximal interphalangeal joint

The volar plate prevents hyperextension of the proximal interphalangeal (PIP) joint. Surgical treatment is necessary for displaced middle phalangeal fractures involving more than one-third of the joint surface (Gaine et al., 1998). We report the results of six fingers on six patients with open reduction and pullout suture using polyamide monofilament for volar plate avulsion fractures of the PIP joint. All six patients had traumatic PIP joint dislocations with instability of the PIP joint following manual reduction by the patient or by a doctor at another hospital. Instability of the PIP joint was defined as one demonstrating greatly increased PIP joint hyperextension as compared with that of the contralateral side. The involved fingers had pain and swelling with decrease in active range of flexion of the PIP joint. Allinvolved fingers had volar fracture fragments involving 25%–40% of the articular surface of the base of the middle phalanx when viewed laterally. All fragments were rotated between 90 to 130 . Surgical treatment was performed 1 to 18 days after injury. Through a Bruner incision, the A3 pulley was incised. After retraction of the flexor digitorum profundus tendon, the bony fragment was exposed. The rotated fragment was punctured from the non-articular surface to the fracture surface using straight needle (Figure 1). Two holes were made in both the fragment and in the middle phalanx for the pullout suture identical to the technique used for volar plate arthroplasty. The fracture fragment was reduced manually and the fragment was fixed with a pullout suture using a polyamide monofilament tied over a button (Figure 2). Complete reduction was confirmed with fluoroscopic examination intraoperatively. After surgery, the PIP joint was fixed in a functional position with a short arm splint extending to the fingertip. One week after the operation, the splint