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Outlines current management of upper limb conditions in primary care settings

This information is for primary care physicians and a general summary of current practice 

Please consult a physician directly for management of specific injuries  

Volar Plate Injuries

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 ​

Screen Shot 2020-11-05 at 1.58.20 pm.png

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

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