From the Guidelines
Treatment for a volar plate avulsion fracture typically involves simple immobilization when fracture fragments are small, nonarticular, or minimally displaced, as stated in the American College of Foot and Ankle Surgeons guidelines 1.
Diagnosis and Treatment
The diagnosis of a volar plate avulsion fracture is based on a history of trauma and focal pain on palpation, and is confirmed with radiographic studies 1.
- The American College of Radiology recommends radiography as the initial imaging for suspected acute hand and wrist trauma, including volar plate avulsion fractures 1.
- For patients with suspected finger tendon injuries, radiographs are used to detect fracture fragments, as large fragments may require open reduction and internal fixation 1.
Management
- Simple immobilization is appropriate when fracture fragments are small, nonarticular, or minimally displaced 1.
- For pain management, acetaminophen (500-1000mg every 6 hours) or ibuprofen (400-600mg every 6-8 hours) can be used.
- Early protected motion is important to prevent stiffness, so after 1-2 weeks, gentle active range of motion exercises should begin under the guidance of a hand therapist.
Complications
- Complications can include joint stiffness, chronic pain, or instability if not properly treated, so following the splinting protocol and rehabilitation exercises is essential for optimal recovery.
- Large fracture fragments (>30% of the joint surface) or significant joint instability may require surgical fixation, as indicated by the American College of Radiology 1.
- MRI may be used to diagnose tears that do not involve the underlying bone, and to assess capsule and collateral ligament injuries of the proximal interphalangeal and metacarpophalangeal joints 1.
From the Research
Volar Plate Avulsion Fracture Treatment
- Early active mobilisation is a recommended treatment approach for volar plate avulsion fractures, as it provides a good result for stable joints with minimal or no splintage 2.
- The size and displacement of the avulsed fragment do not affect the outcome of the treatment 2.
- Patients who present more than three weeks from injury may have a worse outcome, highlighting the importance of early treatment 2.
Operative Treatment
- Operative treatment for volar plate avulsion fractures can involve excision or internal fixation, with the choice of treatment depending on factors such as the size of the fragment and the extent of articular surface involvement 3.
- Fractures treated with fixation tend to have larger fragments and shorter preoperative periods, while those treated with excision may have smaller fragments and longer preoperative periods 3.
- The results of operative treatment, including postoperative pain, patient satisfaction, and grip and pinch strength, do not differ significantly between excision and fixation methods 3.
Chronic Volar Plate Avulsion
- Chronic volar plate avulsion injuries can cause chronic pain and limitation of movement, despite a stable joint, and may require surgical intervention 4.
- A surgical technique involving the repair of the volar plate and creation of a new connection to the middle phalanx can result in significant improvement in range of motion, pain, and overall function 4.
- This technique allows for early motion and can be effective in treating chronic volar plate avulsion injuries, with all patients experiencing improved range of motion and reduced pain following surgery 4.