How long should high-impact activities be avoided after a volar plate avulsion fracture?

Management of Volar Plate Avulsion Fractures: Activity Restrictions

High-impact activities should be avoided for 6-8 weeks following a volar plate avulsion fracture, after which normal activities can be resumed if the joint is stable and healing appropriately. 1

Initial Assessment and Classification

• Volar plate avulsion fractures require proper assessment to determine stability and treatment approach:
  • Standard radiographs (posteroanterior, lateral, and oblique views) are recommended for initial diagnosis 1
  • CT without contrast may be needed to confirm fracture and assess fragment size if radiographs are equivocal 1
  • MRI can evaluate associated soft tissue injuries, particularly volar plate tears 1

Treatment Approach Based on Fracture Characteristics

Conservative Management

• Indicated for fractures with:
  • Less than 50% joint involvement
  • Stable joint
  • Minimal displacement (less than 10 degrees angulation) 1

Surgical Management

• Consider surgery if:
  • Fracture involves more than 50% of articular surface
  • Unstable joint
  • Displacement with interfragmentary gap >3mm
  • Significant angulation (>10 degrees)
  • Malrotation 1

Activity Restrictions Timeline

First 2 Weeks

• Extension stop splinting is typically recommended 2
• Early active mobilization with minimal splintage provides good results for stable joints 3
• Avoid high-impact activities completely during this period

2-6 Weeks

• Coban bandage may be used until 6 weeks post-injury 2
• Continue to avoid high-impact activities
• Progressive return to light activities as tolerated

After 6-8 Weeks

• No restriction of physical activity is necessary after 6-8 weeks if healing is appropriate 1
• Return to high-impact activities can be considered based on:
  • Absence of pain
  • Restoration of full range of motion
  • Adequate strength recovery
  • Radiographic evidence of healing

Monitoring and Complications

• Regular assessment of healing progress is essential 1
• Watch for common complications:
  • Joint stiffness
  • Chronic pain
  • Flexion contracture (occurs in approximately 23% of cases) 2
  • Post-traumatic arthritis 1

Special Considerations

• Patients presenting more than three weeks from injury tend to have worse outcomes 3
• Ultrasound monitoring can be helpful to assess volar plate healing and guide return to full mobilization 2
• For patients with residual contracture at 4 months, dynamic splint therapy may be needed 2

Rehabilitation Approach

• A directed home exercise program including active motion exercises helps prevent stiffness 1
• Early mobilization after stable fixation provides better function and reduced pain 1
• Physiotherapy is rarely required for uncomplicated cases 3

The evidence strongly supports a 6-8 week restriction from high-impact activities, with early active mobilization for stable injuries producing excellent outcomes in 98% of cases 3. This approach balances the need for adequate healing time while preventing complications from prolonged immobilization.