Volar Plate Injuries

Outlines current management of upper limb conditions in primary care settings

Mechanism of Injury: Hyperextension of the PIPJ and/or dorsal dislocation of the PIPJ

Role of Volar Plate: PIPJ stability and preventing hyperextension

Associated injuries: Collateral Ligaments, Central slip, Middle/Proximal Phalanx Fracture

Differential Diagnosis: FDP Avulsion Fracture, Pilon Fracture/Dislocation

Type 1 + 2: Volar plate +/- Collateral Ligament Injury

Referral to ULQ Specialist or Hand Therapist for review

No PIPJ dislocation
Partial or complete tear of the volar plate (bony avulsion or soft tissue)
Stable PIPJ (assess collateral ligaments, volar plate and central slip tendon)
- Stable PIPJ with < 10% of articular surface affected:
  - Buddy strap affected finger to adjacent finger
- Stable PIPJ with 10-30% of articular surface affected:
  - Dorsal extension blocking splint with PIPJ at 20° flexion if available OR buddy strap and review with ULQ specialist
Differential Diagnosis:
- FDP Avulsion - see below

Stable VP Avulsion

Buddy strapping

Dorsal Extension Blocking Splint

Type 3 + 4: Volar Plate + Dorsal Dislocation +/- Middle or Proximal Phalanx Fracture

Referral to ULQ Specialist immediately

Dorsal dislocation +/- middle or proximal phalanx fracture
Unstable PIPJ - fracture affecting >30% of the articular surface
- compromised lateral stability (collateral ligaments)
- no end feel with hyperextension (volar plate)
Differential Diagnosis:
- Pilon fracture - see below

Dorsally Dislocated PIPJ

Differential Diagnosis

FDP Avulsion
- The FDP tendon can avulse from the volar distal phalanx, become caught at the A3 pulley, and masquerade as a volar plate avulsion fracture.
- Assess FDP tendon function (DIPJ flexion). The "volar plate avulsion" may instead be a FDP avulsion injury.
- Requires surgical management - Review with a ULQ specialist immediately

Pilon Fracture Dislocation
- Can look like an innocuous volar plate injury on imaging.
- The difference between a volar plate injury and a pilon fracture dislocation is: the joint remains dorsally subluxed even with the PIPJ in flexion.
- Look for the "v" sign formed by the middle and proximal phalanx at the dorsal PIPJ (see images on right)
- Requires surgical management - Review with a ULQ specialist immediately

FDP Avulsion