I. Mechanism

  1. Volar plate injured in hyperextension of affected joint
    1. Usually affects PIP joint
    2. Partial or complete tear or avulsion Fracture
    3. Often occurs when the finger is dislocated dorsally
  2. Associated with PIP Collateral Ligament Injury

II. Signs

  1. Tenderness at affected joint at volar aspect
  2. Evaluate collateral ligaments for stability
  3. Range of motion remains intact if stable joint

III. Imaging: XRay

  1. Avulsion Fracture may be present

IV. Management

  1. Referral indications
    1. Unstable joint
    2. Large avulsion Fracture
  2. Moderate, but stable injury (most cases)
    1. Progressive extension splint (block splint)
    2. Aluminum splint initially angled 30 degrees flexion
    3. Progressively decrease flexion weekly by 5-10 degrees
      1. Week 1-2: 30 degrees
      2. Week 2-3: 20 degrees
      3. Week 3-4: 10 degrees
      4. Week 4: Full extension
    4. Buddy taping for an additional 2 weeks
  3. Mild injury
    1. Buddy taping to adjacent finger for 4 weeks
  4. Sport participation
    1. May participate if splinted or buddy taped

V. Complications

  1. Hyperextension deformity

Images: Related links to external sites (from Google)