Pediatric Volar Plate Management: A Pilot Study.

BACKGROUND: Proximal interphalangeal (PIP) joint volar plate injuries are common hand injuries in children. Commonly employed treatments include splinting or buddy taping, with no consensus regarding best practice. This pilot study compares outcomes by treatment protocol for children with PIP joint volar plate injuries and informs a power calculation for a larger study. METHODS: A prospective observational pilot study of children with stable PIP joint volar plate injuries was conducted. Standard treatment protocols were: 1 or 2 weeks of splinting followed by buddy taping, or direct to buddy taping. Patient-reported pain and range of motion (ROM) at 1 to 2 weeks and 4-weeks post injury, as well as time to return to activity were analyzed. A power calculation for a future equivalency study was performed. RESULTS: Ten patients per group were included in the study. At 1 to 2 weeks, the direct-to-buddy taping group had significantly greater active ROM and less pain than the 1-week splinting group (ROM 99o vs 78o, P = .03; FACES 1.6 vs 5.0, P = .02). At 4-weeks, there were no differences in ROM and pain by treatment group. Only one patient (direct to buddy taping) did not return to activity due to pain. Using pain with active ROM at 4-weeks, a sample size of 27 patients per group for an equivalence study was determined. CONCLUSION: This pilot study suggests similar outcomes at 4-weeks postinjury by 1 or 2 weeks of splinting followed by buddy taping, or direct to buddy taping treatment. These findings support performing a larger equivalency trial.