title: A Simplified Lateral Hinge Approach to the Proximal Interphalangeal Joint.
abstract: Proximal interphalangeal joint replacement is an effective treatment for painful arthritis affecting the joint. However, the complication rate is relatively high, with many of these complications related to soft-tissue imbalance or instability. Volar, dorsal, and lateral approaches have all been described with varying results. We describe a new simplified lateral hinge approach that splits the collateral ligament to provide adequate exposure of the joint. Following insertion of the prosthesis the collateral ligament is simply repaired, side-to-side, which stabilizes the joint. As the central slip, opposite collateral ligament, flexor and extensor tendons have not been violated, early active mobilization without splinting is possible, and the risk of instability, swan-neck, and boutonniere deformity are reduced. The indications, contraindications, surgical technique, and rehabilitation protocol are described.
authors.affiliation: *Department of Orthopaedics and Trauma †Discipline of Anatomy and Pathology, University of Adelaide ‡Department of Orthopaedics and Trauma, Modbury Public Hospital §Department of Orthopaedics and Trauma, Royal Adelaide Hospital, Adelaide, SA, Australia ∥Department of Hand Surgery, Norrland's University Hospital ¶Department of Anatomy, Integrative Medical Biology, Umea University, Umea, Sweden.
authors.forename: Gregory I
authors.initials: GI
authors.lastname: Bain
authors.forename: Duncan T
authors.initials: DT
authors.lastname: McGuire
authors.forename: Aleksandra M
authors.initials: AM
authors.lastname: McGrath
mesh_terms: D001168:Arthritis / Q000601:surgery*; D050806:Arthroplasty, Replacement, Finger / Q000379:methods*; D017885:Collateral Ligaments / Q000601:surgery*; D005384:Finger Joint / Q000601:surgery*; D006801:Humans; D007595:Joint Prosthesis; D018579:Patient Selection