Executive Editor: Chris Colton

Authors: Fiesky Nuñez, Renato Fricker, Matej Kastelec, Terry Axelrod

Middle phalanx - Proximal, volar plate avulsion

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Glossary

General considerations

Avulsion fractures of the volar plate are very common injuries, often resulting from sporting injuries and usually involving the middle and ring fingers. Several classification systems for them have been proposed for them. The Eaton classification is useful and practical. Its premise is that successful treatment must be based on the stability of the fracture, which in turn depends on:

  • size of the fragment
  • degree of impaction
  • ruptures of one or both collateral ligaments
  • direction of the dislocation (palmar, lateral, or dorsal)
Lag screw fixation of volar plate
Main indication Skill Equipment
Joint instability with a moderate to large fragment, minimal fragmentation Some specialized surgical experience Simple surgical and imaging resources

Contraindications

  • Crushing or extensive fragmentation of the volar plate fragment
Suture fixation
Main indication Skill Equipment
Tiny volar fragment, essentially a soft tissue repair Some specialized surgical experience Basic equipment only

Contraindications

  • Grossly contaminated wound
Volar plate arthroplasty
Main indication Skill Equipment
Extensive fragmentation and impaction of the volar fragment with joint instability Some specialized surgical experience Basic equipment only

Contraindications

  • Fragment greater than 40-50% of the joint surface
*Skill
Basic surgical experience, no specialized skills Basic surgical experience, no specialized skills
Some specialized surgical experience Some specialized surgical experience
Highly experienced and skilled surgeon Highly experienced and skilled surgeon
*Equipment
Basic equipment only Basic equipment only
Simple surgical and imaging resources Simple surgical and imaging resources
Full specialized surgical and imaging resources Full specialized surgical and imaging resources

v1.0 2008-11-08