Keifhaber-Stern classification of volar plate avulsion injuries

Last revised by Arlene Campos on 8 May 2024

The Keifhaber-Stern classification can be used to classify volar plate avulsion injuries of the fingers.

Along with the Eaton classification, this classification is considered (c. 2016) one of the most useful for the management of volar plate avulsion injuries 2.

For Keifhaber-Stern classification "stable" or "tenuous", conservative management is recommended with surgical management for "unstable" injuries 2.

According to this classification, there are three types of volar plate avulsion injury 1,2:

  • stable avulsion fracture involving <30% of the articular base of the middle phalanx

  • tenuous avulsion fracture involving 30%-50% of the articular base of the middle phalanx; reduces with <30° of flexion

  • unstable avulsion fracture involving <50% articular base of the middle phalanx but requires >30° flexion to maintain reduction

The classification was proposed originally by Hastings and later modified by Keifhaber and Stern in 1998 1.

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