Surgical Management of Volar Lip Fractures of the Middle Phalanx: A Case Series on Diverse Techniques and Outcomes, Do Acute and Chronic Presentations Differ in Outcome?

Introduction: Volar lip fractures of the middle phalanx are uncommon but potentially debilitating intra-articular injuries, typically resulting from axial loading combined with hyperextension or dorsal dislocation. They frequently involve avulsion of the volar base of the middle phalanx along with the volar plate, compromising joint congruity and stability. The management of such fractures ranges from non-operative care for small stable fragments to open reduction and internal fixation, volar plate repair, hemi-hamate arthroplasty, or dynamic external fixation in unstable or chronic cases. Case Series: This series reports five cases of volar lip fractures of the middle phalanx presenting at variable intervals and managed with variable surgical techniques at a tertiary care center which includes: (1) Mini-screw fixation in acute case, (2) mini-screw fixation combined with K-wire stabilization, (3) hemi-hamate arthroplasty, (4) JESS external fixation, (5) mini-screw fixation in a chronic case. Post-operative care included protective splinting for 2–4 weeks, suture removal at 2–3 weeks, and initiation of mobilization with strapping, followed by structured physiotherapy. Comparative analysis revealed that acute cases (Cases 1, 2, and 4) achieved superior outcomes with primary fixation techniques, showing better post-operative proximal interphalangeal joint range of motion, lower Disabilities of the Arm, Shoulder and Hand (DASH) scores, and lower Visual Analog Scale (VAS) pain scores. Chronic cases (Cases 3 and 5) required reconstructive or delayed fixation, yielding restricted motion, higher DASH scores, and higher VAS scores. Conclusion: Volar lip fractures of the middle phalanx, though rare, have significant functional implications. Early anatomical reduction and fixation provide the best chance for restoring stability, mobility, and hand function. Chronic or neglected injuries often demand salvage procedures such as hemi-hamate arthroplasty, which can achieve functional but limited outcomes. Our case series highlights that timely surgical intervention and structured rehabilitation are key determinants of optimal recovery. Keywords: Volar lip fracture, proximal interphalangeal joint, hemi-hamate arthroplasty, mini-screw fixation, Jess external fixator.