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Volar Plate Fracture

 

  • Volar plate forms floor of PIP joint and separates the joint space from the flexor tendons
    • Volar plate is ligamentous at its origin on the proximal phalanx
    • Cartilaginous in its insertion onto the middle phalanx
  • Hyperextension injury
  • Involves PIP joint of fingers
  • Primarily a ligamentous injury that can result in fracture
  • Injury to the PIP joint is relatively common in athletics, especially sports involving ball-handling
    • “Jammed finger”
  • If force of injury is great enough, dorsal dislocation can occur
    • Rupture of volar plate may occur with longitudinal splitting of the collateral ligament structures
      • Allows for complete dorsal displacement of middle phalanx
      • Simple dislocations easily reduced by player coach, or trainer on the field
      • Following reduction, most dorsal dislocations are stable
  • Fractures of base of middle phalanx also occur in association with dorsal dislocations
    • If fracture involves more than 40-50% of articular surface
      • Collateral ligament support is lost
      • Combined with coexistent volar plate disruption
        • Represents major loss of joint stability
        • These injuries are often unstable, exhibiting persistent subluxation of the middle phalanx
  • Imaging findings
    • Small fragment of bone is avulsed from palmar (volar) aspect of base of middle phalanx

There is a small avulsed fragment of the base of the middle phalanx from a volar plate injury

 

  • Complications
    • Joint instability
    • Associated collateral ligament tear may heal with abundant fibrous tissue producing bump on one side of joint

 

 

 

 

Michael E. Robinson, MD  eMedicine

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