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Early mobilisation for volar plate avulsion fractures
  1. Richard Body, Clinical Research Fellow,
  2. Craig J Ferguson, Clinical Research Fellow
  1. Department of Emergency Medicine, Manchester Royal Infirmary, Oxford Road, Manchester, M13 9WL, UK; s.carley1btinternet.com

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    Report by Richard Body, Clinical Research FellowChecked by Craig J Ferguson, Clinical Research Fellow

    A short cut review was carried out to establish whether rest or mobilisation is best for volar plate avulsion fractures. A total of 73 papers were found using the reported search, of which two represented the best evidence to answer the clinical question. The author, date and country of publication, patient group studied, study type, relevant outcomes, results, and study weaknesses of these best papers are tabulated. A clinical bottom line is stated.

    Three part question

    In [adults with volar plate avulsion fractures] does [early mobilisation or splintage] lead to [superior functional outcome]?

    Clinical scenario

    A 30 year old man presents to the emergency department a few hours after a hyperextension injury to his index finger. A radiograph demonstrates an avulsion fracture at the volar plate of the proximal interphalangeal joint. You wonder whether splintage or early active mobilisation will lead to a better functional outcome.

    Search strategy

    OVID Medline 1966–September 2004. (volar plate.mp. OR Fingers/ OR exp Finger Joint/ OR proximal interphalangeal joint.mp. OR PIP joint.mp.) AND (exp Fractures/OR exp Fractures, Closed/) AND (exp Early Ambulation/OR mobilisation.mp. OR exp Immobilization/OR strapping.mp. OR splint$.mp.) LIMIT to human and english language.

    Search outcome

    Altogether 73 papers were identified using the reported search, of which two were relevant to the three part question (table 2).

    Table 2

    Comment(s)

    There is a range of opinions about the optimal treatment for small, stable volar plate avulsion fractures. Some advocate immobilisation with aluminium splints, others advocate neighbour strapping and yet others adocate early active mobilisation. Unfortunately there are no randomised controlled trials to compare the efficacy of these interventions. The two trials that were identified suggest that early mobilisation leads to acceptable functional outcomes, which may be at least as good as following immobilisation.

    There is no evidence of harm following early mobilisation. However, the available evidence is insufficient to make an evidence based recommendation for early active mobilisation instead of splintage.

    CLINICAL BOTTOM LINE

    There is insufficient evidence to give firm recommendations whether mobilisation or splintage is best. Local guidelines should be followed.

    Report by Richard Body, Clinical Research FellowChecked by Craig J Ferguson, Clinical Research Fellow

    References

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