Paediatric volar plate injury (ages 16 years and under)

Information for parent/guardian/carer

This leaflet is for the parent/guardian/carer of a child aged 16 and under who has had an injury to their volar plate.

What is a volar plate injury?

The volar plate is a small ligament on the palm side of the joints of your fingers and thumb. This structure helps support the joint and prevents it from being able to over straighten (hyper-extend) or dislocate. The most common volar plate injury is to the middle joint of your finger, as illustrated.

When injured it can be partially or fully torn and may sometimes pull off a small piece of bone, this is called an avulsion fracture. This injury is usually caused by an impact to the finger, such as a ball hitting the end of a finger or a fall. A volar plate injury normally takes six weeks to heal.

What to expect

It is completely normal for your child to experience pain, swelling and bruising in the injured finger or thumb. It is also very likely they will temporarily lose some movement in the finger. These symptoms can last anywhere from one to six weeks after injury. You should notice that over time these symptoms improve and settle down and the full range of movement returns.

Treatment

Most volar plate injuries in children can be managed at home without the need for hand therapy.

Home treatments should include:

• Remove any rings from the injured finger and avoid putting them back on until the pain, swelling and bruising have all resolved.
• In the first few days, ice wrapped in a tea towel and placed over the injury for 15 to 20 minutes, three times a day will help with the pain, bruising and swelling.
• You can give your child their usual over-the-counter (bought from a shop without a prescription) pain relief as needed.

Strapping the finger to a neighbouring one, as shown below, will provide some support and protection to the finger as it heals. This can be done by using tape or a double tubigrip (also called a Bedford sleeve). With the strapping in place, your child will still be able to bend their fingers. It is recommended the finger is strapped to the neighbouring one for approximately two to three weeks after injury. Keep the strapping on day and night but can be removed so your child can carefully wash their hand. After this time the strapping can be worn at night and/or at school if your child is still complaining of pain and swelling.

Gentle exercise (see photos below) will help to return movement in the finger and reduce swelling. Each exercise should be completed four times a day, five repetitions each time.

Exercises may be uncomfortable, but your child shouldn’t experience a lot of pain while completing them. These exercises can be started from three days after the injury, although gentle movements before this are fine, as pain allows. Only allow the fingers to straighten to a neutral position, don’t allow them to move into hyperextension.

Things to avoid

For six weeks post injury it is advisable to avoid hyperextension (over straightening) of the injured finger or thumb. Children at school should avoid sports like netball and rugby for six weeks after the injury.

What next?

You will be contacted by the hand therapy department within two weeks to offer and arrange a video call appointment, your child will need to attend the appointment with an adult accompanying them. When you are contacted, if you feel the appointment is not required and you have no concerns about your child’s finger or thumb, you can decline the appointment and instead your child will be offered a patient-initiated follow-up for two months in case any problems arise.

Things to look out for

The pictures below show possible complications from a volar plate injury although in children are they rare.

If your child becomes unable to straighten their finger or the end joint of the finger is bent over and the middle joint hyperextends (over straightens) please contact the hand therapy clinic. If they already have a video call booked in, please contact the clinic so we can book in a face-to-face appointment instead.

Contact details

Occupational Therapy Hand Therapy department, clinic 30

Telephone number 01223 216769

Email clinic 30

My Chart

We would encourage you to sign up for MyChart. This is the electronic patient portal at Cambridge University Hospitals that enables patients to securely access parts of their health record held within the hospital’s electronic patient record system (Epic). It is available via your home computer or mobile device.

More information is available on our website: My Chart