How long should weight bearing be avoided with a volar plate avulsion fracture?

Management of Volar Plate Avulsion Fractures: Weight Bearing Recommendations

For volar plate avulsion fractures, weight bearing should be avoided for approximately 2 weeks, after which protected weight bearing with a splint that limits dorsiflexion can be initiated. 1

Initial Management and Immobilization Period

• Volar plate avulsion fractures should be immobilized with an extension stop splint for the first 2 weeks to prevent hyperextension and allow initial healing 2
• During this initial period, complete avoidance of weight bearing through the affected joint is recommended to prevent displacement of the fracture fragment 3
• Active finger motion exercises should be initiated immediately following diagnosis to prevent stiffness, which is one of the most functionally disabling adverse effects of hand fractures 1

Progression to Protected Weight Bearing

• After the initial 2-week period, patients can begin protected weight bearing with a splint or modified cast device that limits dorsiflexion to prevent compromise of the healing volar plate 2
• This approach is supported by evidence from studies of other fractures where early protected weight bearing (≤2 weeks) with devices limiting dorsiflexion showed improved outcomes 4
• The average extension-stop-splint wear duration is approximately 16 ± 2 days, after which transition to a less restrictive support like Coban bandage can occur 2

Monitoring and Follow-Up

• High-resolution ultrasound can be used to assess volar plate healing and guide safe return to full range of movement without requiring additional X-rays 2
• Follow-up assessments should be performed every 2 weeks for the first 3 months to monitor healing progress and adjust the rehabilitation protocol accordingly 2
• Radiographic follow-up after the initial 2 weeks should be considered only if clinically indicated (e.g., new trauma, significant pain, loss of range of motion, or neurovascular symptoms) 1

Long-Term Rehabilitation

• Complete rehabilitation typically takes 6 weeks, with the Coban bandage support continuing until this time 2
• Early active mobilization with minimal or no splintage provides good outcomes in 98% of cases for stable joints 5
• Patients with residual contracture at 4 months post-injury may require dynamic extension splints for an additional 3-5 months 2

Important Considerations and Pitfalls

• Delayed presentation (>3 weeks from injury) is associated with worse outcomes, highlighting the importance of early diagnosis and appropriate management 5
• Flexion contracture is a common complication that may be reduced by using night splints in full extension and Coban bandage during the day 2
• Patient compliance with the splinting protocol is crucial for preventing complications such as joint instability or need for surgical intervention 2
• The size and displacement of the avulsed fragment does not significantly affect outcomes when appropriate management protocols are followed 5

Special Circumstances

• If joint instability develops during follow-up (seen in approximately 5% of cases), surgical intervention may be required 2
• Patients with concomitant collateral ligament rupture may experience greater extension lag despite similar overall surgical outcomes 3
• For chronic volar plate avulsion injuries with persistent pain and limitation of movement, surgical repair may be considered after conservative management fails 6