Imaging description

A volar plate fracture of the finger is used to describe a traumatic avulsion fracture of bone from the volar lip of the base of the middle phalanx. The fracture fragment is best seen on the lateral radiographic view of the finger and is seen to arise from the volar lip of the middle phalangeal base (Figure 41.1). This avulsion fracture is caused by sudden traumatic hyperextension at the proximal interphalangeal (PIP) joint while the finger is mildly flexed. Because the connective tissue of the volar plate is thick, an isolated rupture of the volar plate without an avulsion fracture is rare. Advanced imaging is usually not indicated.

Importance

A volar plate fracture of the middle phalanx must be identified, as it needs to be treated early to prevent chronic pain, stiffness, and swelling. Untreated volar plate fractures will lead to increasing pain, instability, and stiffness. A non-displaced, small (< 30% of the articular surface) volar plate fracture can be treated conservatively with a splint for a few weeks. If the fragment is displaced or larger, the injury should be evaluated by and potentially treated by a surgeon.

Typical clinical scenario

A 22-year-old male presents with a right ring finger injury that was caused by forced hyperextension of the finger while playing football the night before. There is significant focal pain and swelling about the PIP of the ring finger. The treating physician closely examines the digit to ensure there is no appreciable instability at the joint. A radiograph of the ring finger is obtained to determine if there is a displaced or large fracture fragment, as this will require evaluation by a surgeon with potential surgical treatment. The radiograph is also obtained to ensure there is no significant subluxation at the PIP joint of the right ring finger as this may also require evaluation by a surgeon.