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Dorsal Block Splinting of Volar Plate Injuries at Neutral Position

Stanley, Edward A., MBBS, PGDipAnat, BPhysio*; Seifman, Marc A., MBBS, BMedSc, FRACS (Plas)*; Mills, Bernice, BOT*; Fay, Pearse, BOT, GradCertHealth*†; Thomas, Damon J., MBChB, FRACS (Plas)*‡

doi: 10.1097/SAP.0000000000001820
Hand Surgery
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Purpose Volar plate injuries of the proximal interphalangeal joint (PIPJ) of a finger are common, often occurring in sporting or workplace incidents. Treatment of a stable dorsal dislocation entails a conservative approach, directed at preventing hyperextension and allowing the ligament to heal in position that does not negatively impact on healing. Current treatment regimens include dorsal block splinting (DBS) in 30° of flexion, which maintains the PIPJ in flexion in order to prevent any strain on the healing tissue while attempting to restore anatomical position. Recognized complications of DBS are flexion deformities of the joint and hyperextensibility. We propose that DBS in neutral position, rather than 30° flexion, reduces hyperextensibility as well as preventing flexion deformities of the PIPJ, allowing sooner return of function and participation in daily activities.

Methods A retrospective review of patients sustaining volar plate injuries was undertaken. Inclusion criteria involved patients splinted at either 30° or neutral position, both those having undergone surgical or conservative regimens and the joint assessed as stable. Data were collected focusing on the number of hand therapy sessions, the time from injury to discharge, active angles of flexion and extension of the PIPJ, and pain.

Results Over 2 years, 125 patients were treated for volar plate injuries: 20 with DBS at neutral position and 105 DBS at 30°. There were no significant differences in patient demographics. There were fewer hand therapy appointments required for those splinted in neutral position and weeks of hand therapy predischarge. There were no flexion deformities for patients undergoing DBS at neutral position, but no difference in PIPJ extension. There were no differences in hyperextensibility or pain.

Conclusions Dorsal block splinting at neutral position results in fewer flexion deformities following volar plate injuries of the PIPJ, without resultant hyperextensibility. There are fewer demands on hand therapy. Dorsal block splinting at neutral position may result in better function for patients suffering this injury, with decreased complications and quicker return to daily activities.

From the *Department of Plastic, Reconstructive and Hand Surgery, University Hospital Geelong, Barwon Health; and

Occupational Therapy Program, School of Health and Social Development, Deakin University, Geelong; and

Melbourne Institute of Plastic Surgery, Malvern, Victoria, Australia.

Received September 9, 2018, and accepted for publication, after revision November 26, 2018.

Conflicts of interest and sources of funding: none declared.

Reprints: Edward A. Stanley, MBBS, PGDipAnat, BPhysio, Austin Hospital, 145 Studley Rd, Heidelberg, Victoria 3084, Australia. E-mail: e.stanley@bigpond.com.

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