The JAY (Joint Active Yoke) orthosis for a complex pip fracture-dislocation with failed volar plate repair: A case report

This case report details the postsurgical rehabilitation and outcome of a 57-year old neurosurgeon who underwent hemi-hamate arthroplasty and volar plate repair for a complex ring finger proximal interphalangeal (PIP) fracture-dislocation sustained after a fall while snowboarding. Following re-rupture and repair of his volar plate, the patient was fitted for a “yoke” relative motion flexor orthosis, termed a JAY (Joint Active Yoke) orthosis, in a manner reverse to that which is commonly used for extensor-related injuries. A 57 yo right hand-dominant male who suffered a complex PIP fracture-dislocation with failed volar plate repair undwent hemi-hamate arthroplasty and early active motion following using a custom-fabricated joint active yoke orthosis. The purpose of this study is to illustrate the benefits of this orthosis design in allowing for active controlled flexion of the repaired PIP joint with assist from the adjacent fingers, while also reducing joint torque and dorsal displacement forces. A satisfactory active motion outcome was achieved with maintenance of PIP joint congruity allowing the patient to return to work as a neurosurgeon at 2-months post-operatively. There is little published literature on the use of relative motion flexion orthoses following PIP injuries. Most current studies are isolated case reports on boutonniere deformity, flexor tendon repair, and closed reduction of PIP fractures. The following therapeutic intervention was considered an important contributor to a favorable functional outcome, as it minimized unwanted joint reaction forces in a complex PIP fracture-dislocation and unstable volar plate. Future research with greater level of evidence is required to establish the various applications of relative motion flexion orthoses, as well as determine the appropriate time at which to place the patient in a relative motion orthosis following operative repair to prevent long-term stiffness and poor motion.