The palmar approach is indicated mainly for volar plate avulsion fractures
of the base of the middle phalanx, for fracture dislocations of the proximal
interphalangeal (PIP) joint, or for comminuted, impacted fractures of the base
of the middle phalanx.
An exception to this rule is a dorsal central slip avulsion fracture of the
base of the middle phalanx, with palmar dislocation, that can not be approached
via a palmar exposure, and the dorsal route becomes the first choice.
The palmar approach is also indicated for volar plate arthroplasty.