Volar Plate Injuries

Volar plate (VP) injuries are very common and typically a simple injury to manage.  However, early diagnosis and treatment is key to ensuring a good clinical result.  The consequences of delayed treatment may result in complications that require extended periods of hand therapy input and a delay in returning to work and sports.

Case Study:  Steve, 28 year old male.

Steve plays B grade amateur AFL.  During football training, Steve marked a ball awkwardly, pushing his right ring finger into hyperextension.  The next day Steve presented to his GP as his finger was swollen at the proximal interphalangeal joint (PIPJ).  X-rays demonstrated that he had a small flake fracture at the base of his volar middle phalanx and was diagnosed with a VP avulsion fracture.

Steve’s initial treatment involved initiating a VP protocol, by fabricating a custom-made thermoplastic finger-based dorsal-blocking orthosis, with the PIPJ at 30 degrees, which keeps the volar plate lax and allows the fracture to unite in correct position.  To manage his oedema, Steve was provided with Coban (elasticated self-adhesive wrap) to place on his finger each day, to provide light compression.  Steve was educated on volar plate pathology, treatment aims, healing timeframes and splint wear and care.  Steve was advised against playing football at this stage.

One week following his initial appointment, Steve’s splint was modified to 20 degrees of PIPJ flexion.  Steve was advised to continue with AROM exercises, as well as starting gentle passive flexion, to ensure he regained full flexion range a this PIPJ and DIPJ.  At Steve’s 2nd and 3rd week review, the orthosis was progressively straightened by 10 degrees each time.  At his 4 week review, he presented with no pain and full range of movement.  Steve progressed straight into a custom-made lycra buddy stall (little and ring fingers), which he was advised to wear full time for the next 2 weeks.

Six weeks post his accident, Steve had no pain on palpation of the volar plate, no pain with stress testing of the volar plate, he had regained full range of motion and all oedema had settled.  Based on clinical assessment, Steve was advised it was now safe to return to playing football.  Education on strapping was provided.  As Steve met all of his hand therapy goals, he was discharged at this point, however, was advised to come back if he had any aggravation of his injury.

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