The extensor tendon splitting approach to the proximal interphalangeal joint: do we need to reinsert the central slip?

Current approaches to the proximal interphalangeal (PIP) joint have potential complications and limitations. We present a dorsal approach that involves splitting the extensor tendon in the midline, detaching the insertion of the central slip and repairing the extensor tendon without reinserting the tendon into the base of the middle phalanx. A retrospective review of 16 digits that had the approach for a PIP joint arthroplasty with a mean follow up of 23 months found a postoperative PIP active ROM of 61 degrees (range 25-90 degrees). Fourteen digits had no extensor lag, while two digits had an extensor lag of 20 degrees and 25 degrees. This modified approach is fast and simple and does not cause an extensor lag.