What is the treatment for a volar plate avulsion fracture of the index finger?

Treatment of Volar Plate Avulsion Fracture of the Index Finger

For stable volar plate avulsion fractures of the index finger, immediate active mobilization without splinting or with minimal splinting provides excellent outcomes and should be the primary treatment approach. 1

Initial Assessment and Treatment Decision

The key determinant is joint stability, not fragment size or displacement:

• Perform a clinical stability test by assessing the proximal interphalangeal (PIP) joint through active and passive range of motion 1
• Fragment size and displacement do NOT predict outcome or dictate treatment 1
• The actual fragment size is typically larger than radiographs suggest due to rotation from volar plate pull 2

Non-Operative Management (First-Line for Stable Joints)

Begin immediate active finger motion exercises without delay - this is the cornerstone of treatment for stable injuries:

• Start active mobilization immediately at the first encounter 1
• Use minimal or no splinting for stable joints 1
• Physiotherapy is rarely required with this approach 1
• 98% of patients achieve excellent or good outcomes with early active mobilization 1

Critical Timing Factor

• Patients presenting within 3 weeks of injury have significantly better outcomes 1
• Delayed presentation (>3 weeks) worsens prognosis regardless of treatment method 1
• This makes early mobilization even more critical to prevent the hand stiffness that becomes extremely difficult to treat after healing 3

Operative Management (For Unstable Joints or Large Articular Involvement)

Surgery is indicated when:

• The joint is clinically unstable on examination 2, 4
• Large articular surface involvement is present 2
• Concomitant collateral ligament rupture exists 4

Surgical Options

Both excision and internal fixation produce similar functional outcomes:

• Fragment excision: Appropriate for smaller fragments or delayed presentation 2
• Internal fixation: Consider for larger fragments, shorter preoperative periods, and greater articular involvement 2
• Fixation methods (Mitek bone anchoring vs. PDS bone suturing) show no significant outcome differences 4

Postoperative Protocol

• Immobilize in dorsal protective splint for 2 weeks only 4
• Begin active range of motion exercises after the 2-week immobilization period 4
• Early mobilization prevents the functionally disabling complication of finger stiffness 3

Expected Outcomes and Complications

• Pure volar plate injuries have better range of motion and less extension lag than injuries with concomitant collateral ligament rupture 4
• Surgical outcomes are successful regardless of collateral ligament involvement, though greater extension lag occurs with ligament injury 4
• Pain, patient satisfaction (VAS), DASH scores, and grip/pinch strength are similar between excision and fixation groups 2

Critical Pitfall to Avoid

Never restrict finger motion in stable injuries - failure to encourage immediate active mobilization leads to severe stiffness requiring multiple therapy visits and potentially surgical intervention 3. This complication is far more disabling than the original injury and is entirely preventable with early motion 3.