A Two-Point Flexion Orthosis for Proximal Interphalangeal Joint Stiffness: Simplified Traction Without Volar Obstruction

Stiffness of the proximal interphalangeal (PIP) joint remains one of the most challenging conditions encountered in hand rehabilitation. When untreated or treated with delay, trauma to the PIP joint often results in progressive capsular contracture, loss of tendon gliding, and functional compromise. Although traditional orthotic management using 3-point pressure systems remains widely adopted, these devices frequently present mechanical limitations as flexion improves, particularly due to volar component impingement. This report describes a novel 2-point static progressive orthosis developed to restore PIP joint flexion without volar obstruction. The orthosis consists of a dorsal thermoplastic base anchored at the metacarpophalangeal (MCP) joint, combined with a semi-rigid dorsal ring placed on the middle phalanx (P2). A dorsal thread passing through the ring applies adjustable flexion traction through an internal-external path, avoiding the palmar side of the joint. The system eliminates the need for volar support and minimises shear forces, allowing greater flexion with increased comfort. The orthosis is fabricated in <20 minutes using low-cost materials and is indicated in patients with post-traumatic or postsurgical flexion deficits where passive range of motion exceeds 60 degrees. It is not suitable for extension contractures or night use. Clinical use suggests that this approach improves the range of motion and patient tolerance while simplifying orthotic design and monitoring. This technique may offer a practical and accessible alternative for therapists and hand surgeons managing flexion contractures of the PIP joint, particularly in cases where conventional orthoses fail due to volar interference.