Adipofascial flap resurfacing of proximal interphalangeal joint after contracture release: Mid-term outcomes

Background: Posttraumatic proximal interphalangeal joint (PIPJ) flexion contracture is a common but difficult problem. Comprehensive literature is sparse, with inconsistent surgical techniques and outcomes. In this study, we describe in detail the volar approach of stepwise release and evaluate the outcomes of using the proximal interphalangeal joint adipofascial flap (PIPJAF) to cover the volar capsule of PIPJ. Methods: In this retrospective cohort study spanning over 12 years, we compared 19 patients with PIPJAF and 16 patients without PIPJAF, with a minimum follow-up of 6 months postoperatively. Results: In the PIPJAF group, there was significant improvement in active flexion arc (70.8°, SD 18.6°) at 6 months, and at 6 months and later significantly better extension lag angle (20.8°, SD 19.2°), improvement in extensor lag angle (29.2°, SD 15.3°), and improvement ratio (0.62, SD 0.33) were observed. Conclusions: There is a modest mid-term benefit in using the PIPJAF. We propose integrating the volar approach with PIPJAF in suitable patients with adequate adipofascial tissue on the lateral aspect of the finger. Level of evidence: III – retrospective cohort study.