We need you! See something you could improve? Make an edit and help improve WikSM for everyone.
Volar Plate Avulsion Injury
From WikiSM
Contents
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
- Fractures
- Dislocations
- Tendinopathies
- Ligament Injuries
- Neuropathies
- Arthropathies
- Nail Bed Injuries
- Pediatric Considerations
- Other
Clinical Features
- General: Physical Examination Hand
- There may be swelling, ecchymosis
- Tenderness over PIPJ
- Pain with passive extension, instability
Evaluation
- Standard Radiographs Hand
- Evaluate for dislocation, avulsion fracture
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
- Swan Neck Deformity
- Chronic stiffness, pain, instability
See Also
External
- Sports Med Review Hand Pain: https://www.sportsmedreview.com/by-joint/hand/
References
Created by:
John Kiel on 25 August 2019 12:31:40
Authors:
Last edited:
16 October 2022 00:19:39
Categories: