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Pediatric Volar Plate Management: A Pilot Study
Katie Garland1,2,3,4, Sophia Shayan5,6, Trina Stephens5
1Division of Plastic Surgery, Western University, London, Canada.
Insights
For children with proximal interphalangeal (PIP) joint volar plate injuries, direct buddy taping showed faster recovery with less pain than splinting. Both treatments resulted in similar outcomes by 4 weeks, supporting further research.
Area of Science:
- Pediatric Orthopedics
- Hand Surgery
- Sports Medicine
Background:
- Proximal interphalangeal (PIP) joint volar plate injuries are frequent in pediatric hand cases.
- Current treatment options like splinting or buddy taping lack a definitive best practice consensus.
- This study addresses the need for evidence-based treatment guidelines in pediatric hand injuries.
Purpose of the Study:
- To compare treatment outcomes for pediatric proximal interphalangeal (PIP) joint volar plate injuries.
- To evaluate the efficacy of splinting followed by buddy taping versus direct buddy taping.
- To inform the sample size calculation for a future larger equivalency study.
Main Methods:
- A prospective observational pilot study was conducted on children with stable PIP joint volar plate injuries.
- Patients were treated with either 1-2 weeks of splinting then buddy taping, or direct buddy taping.
- Outcomes measured included patient-reported pain, range of motion (ROM), and time to return to activity.
Main Results:
- The direct-to-buddy taping group exhibited significantly better active ROM and less pain at 1-2 weeks post-injury compared to the 1-week splinting group.
- No significant differences in ROM or pain were observed between the groups at the 4-week follow-up.
- One patient in the direct-to-buddy taping group experienced a delayed return to activity due to pain.
Conclusions:
- Both treatment protocols (splinting followed by buddy taping or direct buddy taping) yield similar outcomes at 4 weeks for pediatric PIP joint volar plate injuries.
- The findings support the initiation of a larger, powered equivalency trial to confirm these results.
- This research contributes to optimizing treatment strategies for common pediatric hand injuries.
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.
