Anterior approach for proximal interphalangeal joint arthroplasty. A, V-shaped incision allows exposure of flexor tendon sheath and division of A3 pulley. B, Flexor tendons retracted to allow proximal detachment of volar plate. C, Collateral ligament origins completely released. D, Proximal interphalangeal joint hyperextended to expose articular surfaces. Head of proximal phalanx removed with oscillating saw. E, Medullary canals prepared with properly sized burrs. F, Provisional implants are sized, and trial of active motion is shown. Permanent implant is then inserted. G, Volar plate can be split and used to reconstruct collateral ligaments. VP, Volar plate. SEE TECHNIQUE 73.8.