Speaker: Repair of chronic volar plate injury successful in most patients
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BOSTON — A multicenter study focused on long-term outcomes of repair for cases of chronic volar plate injury showed patients had few limitations and achieved full extension of their proximal interphalangeal joints, according to a presenter.
At the American Society for Surgery of the Hand Annual Meeting, Michael Buldo-Licciardi, BS, said, “Volar plate repair for chronic injury results in successful outcomes based on the physical exam, satisfaction level, the upper extremity QuickDASH score and radiographic images.”
Buldo-Licciardi and colleagues at the University of Pittsburgh Medical Center Medical Center and the Hand & Shoulder Center in Wexford, Pennsylvania, performed a manual chart review in which they identified and then contacted for follow-up 10 patients who underwent surgical repair of a chronic volar plate injury at least 1-year postinjury and had a minimum follow-up of 2 years.
The goal of the research was to asses long-term results of volar plate repair in chronic injuries. Researchers hypothesized “volar plate repair for chronic injury would lead to long-term stable outcomes with high patient satisfaction,” Buldo-Licciardi, who is a medical student, said.
Results were based on flexion/extension measured with a goniometer and other findings from a physical exam, the upper extremity QuickDASH score, patient satisfaction and radiographic imaging. Physical exams were performed either in person or via a video visit.
Patients ranged in age from 22 to 76 years (mean age 48 years) and had a mean time from injury to repair of 9 years (range of 1 year to 30 years). The digits involved included one middle finger, four ring fingers and five small fingers, Buldo-Licciardi said.
“The most common presenting symptom was pain in nine out of 10 patients. Three patients had difficulty with sport prior to surgery and three patients had occupational disabilities prior to surgery,” he said.
Results showed patients had preoperative proximal interphalangeal (PIP) joint hyperextension of 15° to 60° that improved such that postoperative extension was 0° to 3° in nine of 10 patients.
“One [patient] had hyperextension of 25° at final follow-up, although from a subsequent injury. All patients had full flexion of their PIP joint at final follow-up,” Buldo-Licciardi said.
“The most common presenting symptom was pain, and zero out of 10 [patients] reported pain at final follow-up. Nine patients reported being very satisfied with their surgery and one reported being satisfied. All 10 patients reported improved function at final follow-up based on the upper extremity QuickDASH score,” he said.
The three patients who had occupational impairment preoperatively based on the QuickDASH score had no functional limitations postoperatively. In addition, the three patients who had sport limitations due their injuries reported being able to return to sports, such as football, volleyball and soccer, at their preinjury level of play, results showed.
“Imaging showed no progression of arthritis,” Buldo-Licciardi said.
During his presentation, Buldo-Licciardi briefly described the surgical technique surgeons at both centers used for the repairs, saying the volar plate was partially released medially and laterally so it could be advanced.
“The insertion site was curated,” he said. “The volar plate was repaired in 20° to 30° of flexion using two anchors with 4-0 braided suture. The lateral edges were repaired to the accessory collateral ligaments. The flexor sheath between the A2 and A4 pulley was placed between the flexor tendons and the repaired volar plate to minimize friction.”
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Buldo-Licciardi M, et al. Paper 40. Presented at: American Society for Surgery of the Hand Annual Meeting; Sept. 29-Oct. 1, 2022; Boston.
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