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Volar Plate Avulsion Injury

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Other Names

  • N/A

Background

  • Volar plate stabilizes the flexor surface of the proximal interphalangeal joint, separating it from the flexor tendon
  • This thickened ligament originates on the proximal phalanx and attaches distally with the joint capsule on the middle phalanx

Pathophysiology

  • Typically occurs as a result of a hyperextension injury of the affected joint
  • Less commonly, crush injuries
  • Often associated with PIPJ dislocation
  • May have associated avulsion fracture
  • Significant instability occurs with >40-50% of joint surface involved

Risk Factors

  • Younger patients

Differential Diagnosis


Clinical Features

  • General: Physical Examination Hand
  • There may be swelling, ecchymosis
  • Tenderness over PIPJ
  • Pain with passive extension, instability

Evaluation


Classification

Eaton Classification

  • Type I: hyperextension mechanism, avulsion of the volar plate and a longitudinal tear of the collateral ligaments[1]
    • The opposing joint surface remain congruent
  • Type II: dorsal dislocation of the PIPJ, avulsion of the volar plate; complete tear of the collateral ligament
  • Type IIIa: fracture-dislocation with an avulsed small fragment. <40% of the articular surface
    • Dorsal aspect of the collateral ligament remains attached to the middle phalanx
  • Type IIIb: fracture-dislocation with fracture, impaction of the articular surface of more than 40%

Keifhaber-Stern Classification

  • Stable: Avulsion fracture involving <30% articular base of the middle phalanx[2]
  • Tenuous: Avulsion fracture involving 30%-50% articular base of the middle phalanx; reduces with <30° of flexion
  • Unstable: Avulsion fracture involving <50% articular base of the middle phalanx but requires >30° flexion to maintain reduction

Management

Nonoperative

  • Extension block splinting in 20-30° flexion
  • Splinting indications
    • Small fragment involving <40% of the articular segment
    • Reducible fracture with < 30 degrees of flexion
  • Hand therapy

Operative

  • Surgical indications
    • A large fragment >40% joint surface
    • >30 degrees of flexion to reduce the fragment
    • Malalignment post-closed reduction

Return to Play

  • Needs to be updated

Complications


See Also


References


  1. Eaton RG, Malerich MM. Volar plate arthroplasty of the proximal interphalangeal joint: a review of ten years' experience. J Hand Surg Am. 1980;5(3):260–8
  2. Kiefhaber TR, Stern PJ. Fracture dislocations of the proximal interphalangeal joint. J Hand Surg Am. 1998;23(3):368–80.
Created by:
John Kiel on 25 August 2019 12:31:40
Authors:
Last edited:
28 October 2020 14:13:42
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