Figure. Lateral radiograph of the left small finger.
A 70-year-old man presents to the office with swelling and deformity of the left small finger after he fell 5 days ago. Lateral radiograph of the left small finger (Figure) shows hyperextension of the proximal interphalangeal (PIP) joint.
What is the best treatment option?
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The patient’s diagnosis is most likely a ruptured volar plate of the small finger. The volar plate is a strong ligamentous structure that prevents hyperextension of the PIP joint. The patient was treated with an oval figure-of-8 extension block splint to prevent PIP hyperextension. He was told to wear the splint at all times for 6 weeks. The figure-of-8 splint acts as an extension block to the PIP joint, preventing hyperextension and allowing the volar plate to heal. Volar plate injuries that involve an avulsion fracture of <40% of the PIP joint surface may be splinted in a 30° extension block splint to help reduce the fracture fragment.1 Volar plate injuries involving >40% of the PIP joint surface are generally treated with surgery.1 Failure to treat volar plate injuries can result in joint stiffness or contracture, subluxation of the PIP joint, swan neck deformities, and hand dysfunction.1,2
Dagan Cloutier, MPAS, PA-C, practices in a multispecialty orthopedic group in the southern New Hampshire region and is editor-in-chief of the Journal of Orthopedics for Physician Assistants (JOPA).
1. Pattni A, Jones M, Gujral S. Volar plate avulsion injury. Eplasty. 2016;16:ic22.
2. Laporte JM, Berrettoni BA, Seitz WH Jr, Winsberg D, Froimson AI. The figure-of-eight splint for proximal interphalangeal joint volar plate injuries. Orthop Rev. 1992;21(4):457-462.