Northwestern University Feinberg School of Medicine

Orthopedic Teaching

Hand Case 12 ED Management

Volar Plate Fracture


ED Management

Isolated avulsion fractures, that involve less than 40% of the articular surface, can be placed in a dorsal finger splint. Dislocations require reduction in the ED by disengaging the middle phalanx, applying traction, and then flexing the PIP joint. A dorsal extension block splint is then placed with the PIP joint in 30° of flexion. This is important to prevent further extension of PIP joint which will exacerbate injury. Patients should have routine follow-up with orthopedics or a hand surgeon.