From the Guidelines
The treatment for volar plate injuries typically involves conservative management for most cases, with surgery reserved for severe injuries, and volar locked plates may be considered for operative fixation in certain cases of distal radius fractures, as they lead to earlier recovery of function in the short term. When considering the management of volar plate injuries, it's essential to prioritize the patient's morbidity, mortality, and quality of life. The initial treatment includes protective splinting of the affected finger in slight flexion (about 20-30 degrees) for 1-2 weeks to allow the volar plate to heal in a functional position 1.
After the initial immobilization period, early protected motion should begin with buddy taping to an adjacent uninjured finger for support while avoiding hyperextension of the injured joint. Pain management can include acetaminophen or NSAIDs such as ibuprofen (400-600mg three times daily) or naproxen (250-500mg twice daily) for 5-7 days, although consideration of multimodal and opioid sparing protocols is recommended when possible 1. Ice application for 15-20 minutes several times daily and elevation of the hand above heart level can help reduce swelling.
Some key points to consider in the treatment of volar plate injuries include:
- Initial immobilization for 1-2 weeks
- Early protected motion with buddy taping
- Pain management with acetaminophen or NSAIDs
- Ice application and elevation to reduce swelling
- Physical therapy focusing on gentle range of motion exercises after the initial protection period
- Avoiding activities that could hyperextend the finger during the healing process, which typically takes 4-6 weeks. Surgical intervention is only necessary for cases with significant joint instability, large avulsion fragments, or volar plate entrapment preventing joint reduction, and the use of volar locked plates may be considered in certain cases of distal radius fractures, as they have been shown to lead to earlier recovery of function in the short term 1.
From the Research
Treatment Options for Volar Plate Injuries
- Conservative treatment is often considered as the first line of treatment for volar plate injuries, especially for stable proximal interphalangeal (PIP) joints 2, 3, 4.
- Buddy taping and extension block splinting are common conservative treatment methods used for volar plate injuries, with no significant difference in treatment outcomes between the two methods 5.
- Conservative treatment typically involves immobilization of the affected joint in a flexed position, followed by gradual mobilization and rehabilitation exercises 2, 3, 4.
- The presence of an avulsion fracture does not seem to affect the outcome of conservative treatment for volar plate injuries 3.
Surgical Intervention
- Surgical intervention may be considered for cases where conservative treatment fails, or for chronic volar plate avulsion injuries with significant pain and limitation of motion 2, 6.
- A technique for repairing chronic volar plate avulsion injuries involves freeing the volar plate from scar tissue, creating a new connection to the middle phalanx, and loosely attaching the volar plate distally 6.
- Surgical repair can result in significant improvement in range of motion, pain, and overall function in patients with chronic volar plate avulsion injuries 6.
Specific Considerations
- For children and adolescents, conservative treatment with dorsal aluminum extension block splinting and taping to adjacent fingers can be an effective treatment option for stable volar plate injuries 4.
- Delayed excision of the fracture fragment may be necessary in some cases where conservative treatment fails, and can result in favorable outcomes 2.