Volar plate avulsion injury - subtle

Case contributed by Bálint Botz

Presentation

The left middle finger was hit by a basketball, the proximal interphalangeal joint is stiff, swollen, movements limited upon presentation.

Patient Data

Age: 12 years
Gender: Male

No immediately discernible fracture line is visible, though the swelling around the PIP joint is apparent. 

After magnifying this region a discrete hairline fracture becomes visible at the palmar aspect of the proximal epiphysis of the middle phalanx (see key image). 

Annotated image

After magnifying this region a discrete hairline fracture becomes visible at the palmar aspect of the proximal epiphysis of the middle phalanx (arrow). 

Case Discussion

A tricky case of nondisplaced volar plate avulsion injury which requires careful scrutiny. Besides the patient history the marked periarticular swelling is another red flag in this situation that directs the reader towards the correct diagnosis. 

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