Management of pediatric volar plate avulsion fractures of the proximal interphalangeal joint : a systematic review
Choi, Hongseo Moon, Seong Hui Lee, Hosouk Barnes, Sabrina Poppy Ma, Yangmyung Jester, Andrea Al-Ani, Sami
Choi, Hongseo
Moon, Seong Hui
Lee, Hosouk
Barnes, Sabrina Poppy
Ma, Yangmyung
Jester, Andrea
Al-Ani, Sami
Affiliation
University of Birmingham; Hampshire Hospitals NHS Foundation Trust; George Eliot Hospital NHS Trust, Nuneaton; Hull York Medical School; Birmingham Women's and Children's NHS Foundation Trust; Aston Medical School, Birmingham
Other Contributors
Publication date
2024-02-21
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Abstract
Background: Sudden, forced hyperextension injuries to the proximal interphalangeal joint leading to volar plate avulsion fractures are common hand injuries in children. Suboptimal management of these fractures can lead to the development of long-term complications such as stiffness and flexion contracture.
Methods: MEDLINE (PubMed), Scopus, Embase, Google Scholar, and Cochrane CENTRAL databases were systematically searched, and additional studies were found through reference of articles up to June 15, 2023. Identified articles were assessed using predetermined inclusion/exclusion criteria.
Results: Twenty-five articles were included, involving 268 patients with ages from 3 to 17 years. Fractures with less than 30% joint involvement, classified as Eaton type I or II, or designated as "Stable" in the Keifhaber-Stern classification, were treated through nonsurgical means. Surgical interventions, encompassing open reduction and internal fixation, were reserved for fractures with more than 30% joint involvement and/or meeting criteria such as Eaton type IIIa or IIIb and Keifhaber-Stern "Tenuous" or "Unstable." Positive outcomes were seen in 99.5% of patients receiving nonsurgical treatment, compared with 85.7% in the surgical cohort.
Conclusions: The literature demonstrated positive outcomes for fractures presenting with less than 30% joint involvement that were managed nonsurgically. In fractures with more than 30% joint involvement, surgical interventions yielded positive results. To further substantiate these findings, larger prospective studies with uniform measures are needed to validate the results of this study.
Keywords: children; management; palmar plate avulsion fracture; proximal interphalangeal joint; volar plate avulsion fractures.
Citation
Choi H, Moon SH, Lee H, Barnes SP, Ma Y, Jester A, Al-Ani S. Management of Pediatric Volar Plate Avulsion Fractures of the Proximal Interphalangeal Joint: A Systematic Review. Hand (N Y). 2025 Jul;20(5):664-674. doi: 10.1177/15589447241231308. Epub 2024 Feb 21.
Type
Article