From the Guidelines
The treatment for a volar plate injury typically involves conservative management with buddy taping and protected motion. For mild to moderate injuries, the injured finger should be buddy-taped to an adjacent uninjured finger for 3-6 weeks, with the proximal interphalangeal (PIP) joint kept in slight flexion to prevent hyperextension, as MRI may be used to diagnose tears that do not involve the underlying bone 1. Active range of motion exercises should begin early to prevent stiffness, but passive extension should be avoided for the first 3-4 weeks. Over-the-counter pain medications like acetaminophen or ibuprofen can help manage pain and inflammation. Ice application for 15-20 minutes several times daily during the first 48-72 hours can reduce swelling. Most volar plate injuries heal well with this approach because the volar plate has good healing capacity when protected from hyperextension forces. For severe injuries with joint instability or avulsion fractures involving more than 30-40% of the articular surface, surgical intervention may be necessary, and MRI can accurately depict the extent of the injury 1. Full recovery typically takes 6-12 weeks, though mild swelling and stiffness may persist longer. Key considerations in managing volar plate injuries include:
- Early diagnosis and treatment to prevent contractures or joint laxity
- Protected motion to prevent hyperextension
- Active range of motion exercises to prevent stiffness
- Pain and inflammation management with over-the-counter medications
- Ice application to reduce swelling
- Consideration of surgical intervention for severe injuries with joint instability or significant avulsion fractures.
From the Research
Volar Plate Injury Treatment
The treatment for volar plate injuries can vary depending on the severity and location of the injury.
- For volar plate injuries of the proximal interphalangeal joint (PIPJ), a conservative approach is often used, which includes dorsal block splinting (DBS) to prevent hyperextension and allow the ligament to heal in a position that does not negatively impact healing 2.
- DBS can be done in either 30° of flexion or neutral position, with the neutral position potentially reducing hyperextensibility and preventing flexion deformities of the PIPJ 2.
- In some cases, immediate mobilization may be recommended, as it has been shown to result in better short-term outcomes compared to cast immobilization 3, 4.
- For chronic volar plate avulsion injuries, a surgical procedure may be necessary, which involves freeing the volar plate from scar tissue and reattaching it to the middle phalanx 5.
- For acceptably reduced intra-articular distal radial fractures, volar plate fixation has been shown to result in better functional outcomes compared to cast immobilization 6.
Treatment Options
- Dorsal block splinting (DBS) in 30° of flexion or neutral position
- Immediate mobilization
- Surgical procedure for chronic volar plate avulsion injuries
- Volar plate fixation for acceptably reduced intra-articular distal radial fractures
Considerations
- The choice of treatment depends on the severity and location of the injury
- The goal of treatment is to prevent hyperextension, allow the ligament to heal, and restore function to the affected joint
- Different treatment options may have varying outcomes, and the best approach may depend on the individual patient's needs and circumstances 2, 3, 4, 5, 6