From the Guidelines
Volar plate injuries should be diagnosed and evaluated using MRI, as it can accurately diagnose tears that do not involve the underlying bone, which is crucial for preventing contractures or joint laxity. A volar plate injury is a sprain or tear of the ligament on the palm side of a finger joint, typically occurring when a finger is forcefully hyperextended. According to the study by 1, MRI is ideal for evaluating tendon injuries and helping with surgical planning, and it can also assess capsule and collateral ligament injuries of the proximal interphalangeal and metacarpophalangeal joints.
Some key points to consider in the management of volar plate injuries include:
- Immobilization with a splint for 1-2 weeks, keeping the finger slightly bent (10-15 degrees of flexion) to promote proper healing
- Ice application for 15-20 minutes several times daily and over-the-counter pain medications like ibuprofen (400-600mg three times daily) or acetaminophen (500-1000mg every 6 hours) to manage pain and swelling
- Gentle range-of-motion exercises after the initial immobilization period to prevent stiffness, while avoiding hyperextension for 4-6 weeks
- Severe tears may require surgical repair, and complications can include joint stiffness, chronic pain, or instability if not properly treated
It is essential to seek medical attention if pain persists beyond 2-3 weeks, if there's significant swelling or bruising, or if the patient is unable to bend the finger normally, as these may indicate a more serious injury requiring specialized care, as noted in the study by 1.
From the Research
Volar Plate Injury Overview
- A volar plate injury is a type of injury that occurs at the proximal interphalangeal joint, often resulting from sudden, forced hyperextension 2, 3.
- This type of injury can lead to chronic pain and limitation of movement, despite a stable joint 2.
Treatment Options
- Surgical repair is a treatment option for chronic volar plate avulsion injuries, which involves freeing the volar plate from scar tissue and reattaching it to the middle phalanx 2.
- Nonsurgical management is also an option for fractures with less than 30% joint involvement, and has been shown to have positive outcomes in 99.5% of patients 3.
- Surgical interventions, such as open reduction and internal fixation, are typically reserved for fractures with more than 30% joint involvement 3.
Outcomes
- Studies have shown that surgical repair of chronic volar plate avulsion injuries can result in significant improvement in range of motion, pain, and overall function 2.
- Nonsurgical management of fractures with less than 30% joint involvement has also been shown to have positive outcomes, with 99.5% of patients experiencing positive results 3.
- Larger prospective studies are needed to further validate the results of these studies and provide more uniform measures 3.