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Novel 3D Quantitative Analysis of the Volar Plate and its Attachments at the Proximal Interphalangeal Joint
Sze Wei Justin Lee, BSc1; Zhi Yang Ng, MBChB1; Quentin Fogg, BSc, PhD2
1Medical School, University of Glasgow, Glasgow, United Kingdom; 2Anatomy, University of Glasgow, Glasgow, United Kingdom

Introduction: The volar plate (VP) and its associated ligaments are important supports and stabilizers of the proximal interphalangeal (PIP) joint. Descriptions of the VP macroscopically and microscopically are limited to highly variable qualitative studies. The purpose of this study is to carry out a quantitative analysis of the VP using a novel 3D technique.

Methods: 16 cadaveric fingers were dissected microscopically. The VP, proper collateral ligament (PCL), accessory collateral ligament (ACL) and check ligaments were traced to their attachments. These were reconstructed in a 3D virtual environment using a digital microscribe and a professional graphics programme. 

Results: The VP is made up of 2 parts; a fibrous distal portion with a mean area (43.38 9.24mm2) which is significantly smaller (p <0.05) than the membranous proximal portion (114.24 31.78mm2). This is because the membranous VP is continuous proximally to the check ligament.  During flexion of the PIP joint, the membranous VP slides posteriorly in relation to the fibrous VP. The mean ulnar (6.21 0.90mm), radial (6.45 1.17mm) and middle (4.30 1.23mm) portions of the fibrous VP describe a tooth-like shape. The VP attaches distally onto the base of the middle phalanx over a mean length of 8.07 1.15mm. 

Laterally, the VP is attached to the ACL and A3 pulley. The ACL (mean area: 36.78 7.83mm2 radial; 34.62 5.85mm2 ulnar) originates from the similarly sized PCL (mean area: 49.99 18.68mm2 radial; 48.68 18.01mm2 ulnar; p>0.05). The proximal length of the ACL (mean area: 5.49 1.05mm radial; 5.67 1.02mm ulnar) were significantly shorter than the distal length of the ACL (mean area: 8.57 1.13mm radial; 8.20 1.27mm ulnar; p<0.05) to permit flexion of the PIP joint.

Conclusion: The structure of the membranous VP is continuous with the bilateral check ligaments hence constituting the VP. The ACL and PCL are not part of the VP but it functions to maintain the structural integrity of the VP. This quantitative study has demonstrated the degree of interaction between the VP and adjacent ligaments, suggesting that these connections should be retained or restored intraoperatively.


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