- [Home](https://ortopediaevolutiva.com/en) - [Pediatric Orthopaedics Blog — Dr. Priano](https://ortopediaevolutiva.com/en/blog) - Volar plate avulsion of the PIP in children: when conservative treatment is sufficient # Volar plate avulsion of the PIP in children: when conservative treatment is sufficient March 25, 2026 2 min read Edited and medically reviewed by [Dr. Daniele Priano](https://ortopediaevolutiva.com/en/about) ![Volar plate avulsion of the PIP in children: when conservative treatment is sufficient](https://qoxwtbnwsrbatawnkgst.supabase.co/storage/v1/object/public/blog-images/blog/fratture-avulsione-volar-plate-pip-bambino-trattamento.jpg) This English version is based on the original Italian article. For wording nuances, you can refer to the Italian version. ## In short, for parents - • Most finger injuries with small bone chips heal well without surgery. - • We focus on how stable the finger joint is, not just the chip. - • Proper splinting and careful follow-up are key for healing. Volar plate avulsions of the PIP are common after hyperextension trauma to the finger, often during sports or play. X-rays may show a small volar bone fragment at the base of the middle phalanx. [1] The presence of the fragment alone does not determine treatment. The percentage of articular surface involved and the stability of the proximal interphalangeal joint are most important. ## What the Review Shows A systematic review published in *HAND* included 25 studies and 268 patients between 3 and 17 years old. In injuries involving less than 30% of the articular surface, classified as Eaton I-II or stable according to Keifhaber-Stern, non-surgical treatment was associated with positive outcomes in 99.5% of reported cases. [1] When articular involvement exceeded 30% or the injury was classified as Eaton IIIa/IIIb or unstable, surgery was used more often. [1] ## How Stable Forms Are Treated In non-surgical cases, splints and buddy strapping were primarily used, often with protected or early mobilization. [1] The goal is to protect the PIP without immobilizing it more than necessary. Prolonged stiffness can become a significant problem even after an initially small injury. ## When More Attention Is Needed A large fragment, subluxation, an unstable joint, or greater articular involvement require a different approach. In these cases, reduction and fixation may be necessary to restore joint congruity. [1] The surgically treated group in the review had positive outcomes in 85.7% of cases. This data should not be directly compared with that of the conservative group, because surgery was used in more severe cases. [1] ## Clinical Assessment Matters as Much as X-rays A swollen and painful finger after being hit by a ball may have a small avulsion and still remain stable. In these cases, conservative management is often sufficient. However, it is useful to re-evaluate the child if the finger remains very stiff, if the pain does not improve, if the joint appears unstable, or if the X-ray shows a larger articular involvement than initially suggested by the trauma. ## Limitations of the Literature The studies included in the review are heterogeneous and predominantly retrospective. Definitions of stability, duration of immobilization, and outcome criteria vary. [1] The most useful message is therefore a clinical one: in stable injuries, conservative treatment works very well; in unstable forms or those with greater articular involvement, surgical indication becomes more concrete. Disclaimer This content is for informational purposes only and does not replace an individual clinical evaluation. References [1] Choi H, Moon SH, Lee H, Barnes SP, Ma Y, Jester A, Al-Ani S. Management of Pediatric Volar Plate Avulsion [Fractures](https://ortopediaevolutiva.com/en/conditions/injuries-fractures) of the Proximal Interphalangeal Joint: A Systematic Review. HAND. 2025;20(5):664-674. doi:10.1177/15589447241231308. PMID: 38380839. PMCID: PMC11571450. ## Complete injuries and fractures pathway This page is part of the paediatric injuries and fractures pathway. The main guide covers the overall picture and the warning signs. - [1 Overview: when an injury is urgent How growing bone behaves, what happens in the emergency room and when an orthopaedic review is useful.](https://ortopediaevolutiva.com/en/conditions/injuries-fractures) - [4 Hand and fingers: recovery after immobilisation Recovery sheet for finger motion after a splint or cast, with the stiffness signs to report.](https://ortopediaevolutiva.com/en/parents-kids/exercises/post-cast/after-finger-cast) [Volar plate avulsions · you are here](https://ortopediaevolutiva.com/en/blog/pip-volar-plate-avulsion-fractures-in-children) - [Seymour fracture](https://ortopediaevolutiva.com/en/conditions/seymour-fracture) - [Non-traumatic hand: a finger that will not straighten](https://ortopediaevolutiva.com/en/conditions/paediatric-trigger-thumb) - [5 Lower limb and ankle Femur, leg, knee and ankle: weight-bearing, healing times and return to walking.](https://ortopediaevolutiva.com/en/conditions/femur-fracture-children) - [6 Imaging, cast and follow-up Growth plate, follow-up X-rays and management of immobilization.](https://ortopediaevolutiva.com/en/conditions/physeal-fractures) ![Dott. Daniele Priano](https://ortopediaevolutiva.com/assets/doctor-avatar-3d-CTvqnoPa.webp) ### Concerned about your child? If you recognize any of these signs in your child, a specialist assessment can give you clarity. I see children at Gaetano Pini and CTO institutes in Milan. 5.0 · Google & MioDottore [Book a private visit](https://ortopediaevolutiva.com/en/locations#prenota) ### Related Conditions [Fractures and trauma](https://ortopediaevolutiva.com/en/conditions/injuries-fractures) ### Related Surgery Pages [Fracture treatment](https://ortopediaevolutiva.com/en/surgery/injuries-fractures) ### Related Articles [Kirschner Wire Infection in Children: When Can It Become Osteomyelitis? Read](https://ortopediaevolutiva.com/en/blog/kirschner-wire-infection-children-osteomyelitis-risk)[Proximal humerus fracture in children: when is surgery really needed? Read](https://ortopediaevolutiva.com/en/blog/proximal-humerus-fracture-children-when-surgery-is-needed)[Growth plate fractures: why does follow-up continue after the bone has healed? Read](https://ortopediaevolutiva.com/en/blog/growth-plate-fractures-follow-up-after-healing) ![Dott. Daniele Priano](https://ortopediaevolutiva.com/assets/doctor-avatar-3d-BiLSxBxW.webp) Author and medical reviewer ## Dr. Daniele Priano [Pediatric orthopaedic care in Milan](https://ortopediaevolutiva.com/en) — Gaetano Pini & CTO [Read full bio](https://ortopediaevolutiva.com/en/about) --- Canonical: https://ortopediaevolutiva.com/en/blog/pip-volar-plate-avulsion-fractures-in-children Le informazioni cliniche sono divulgative e non sostituiscono una valutazione medica diretta.