Ortho Dx: Swelling and Deformity of the Small Finger

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...

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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).

References

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.