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1Principles

Extensive comminution of the palmar margin is the main indication for volar plate arthroplasty of the PIP joint ...

Volar plate arthroplasty

Extensive comminution of the palmar margin is the main indication for volar plate arthroplasty of the PIP joint.
The degree of comminution is often not apparent on the x-rays. These fractures are usually associated with impaction in the subchondral metaphysis.
The more impaction and comminution is present, the less stable is the joint.
These fractures can not be treated by internal fixation. Volar plate arthroplasty is a good option for these fractures.
In order for volar plate arthroplasty to be used, at least 60% of the dorsal articular surface needs to be intact. Loss of more than 40% of the articular cartilage is a contraindication for this procedure, and bone graft reconstruction becomes necessary.

Alternatively, a hinged external fixator may be used.