Volar Plate Avulsion Injury
This is a hyperextension injury which is essentially a ligamentous injury although it may involve a portion of bone avulsed off by a ligament. It usually involves a piece of bone avulsed off the base of the middle phalanx by the volar plate which is usually not significantly displaced and usually will heal without problem. It also usually involves a collateral ligament tear which heals without problem but often heals with abundant scar tissue leading to an appearance of chronic swelling on one side of the joint, which is permanent.
No more than a few days of immobilization is necessary and is important to work on obtaining full range of motion of the joint. The middle joint of the fingers is the worst with regards to stiffness and early range of motion is very important. Range of motion exercises may be explained to the patient or therapy with a hand therapist may be necessary. “Buddy taping” of the fingers after the initial few days of immobilization is all that is necessary for finger support. At first, “buddy taping” will be necessary all the time, gradually progressing to “buddy taping” only with exertive or sporting activities with effected hand. If motion is begun early, full range of motion can be expected. For those who have been immobilized longer, permanent stiffness may result. Rarely, with severe stiffness, surgical release of the scarred tendons and joint capsule may be necessary, also rarely, instability may result which may require reconstructive surgery. Most patients do extremely well, being able to progress to painless activity with full function, with minimal abnormal appearance.
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Dear Dr. Marumoto-Thank you for everything you have done for me. Your skills have enabled me to play sports again and have allowed me to regain an improved quality of life.
Although our visits were brief, I was truly inspired by you. I remain to this day in awe of your professional demeanor as well as you extremely impressive skills as a surgeon. Although you may not have known it, you were critical in my selection of a career in medicine. I hope to emulate you in my professional career.
In January, I was accepted into the John A. Burns School of Medicine, and next month I will start on the path that you have already tread, keeping you in mind as a role model and aiming to become as skillful and as knowledgeable as you.
Although words cannot adequately express my gratitude, thank you again for everything you have done for me. Best wishes to your always. Sincerely C.L
Dear Dr. Marumoto: Thank you for your kindness. My knee is much better. M.F.
Dear Dr. Marumoto-Thank you very much for doing my knee surgery. I am feeling much better after the physical therapy sessions. I hope I can continue doing sports soon!
