Women footballer's fingers at risk

In our clinic this winter we noticed an increased number of women footballers coming in with injured fingers.
Usually these injuries occur from football v tip (sudden hyper extension) or tackling (rotation and hyper extension).
Most common injuries have been volar plate injuries (+/- avulsion fractures). That is, damaging the middle joint (PIPJ) on the palm side of the hand.
 
A few have arrived late having been buddy taped without success.
Buddy taping a volar plate injury will usually not allow for quick healing and delay return to play.

• Volar plate injuries are best treated as a ligament injury (even if there is a bony avulsion fracture). Limiting movement in the direction of the impact, such that the fibers are kept at a shortened position to enable them to heal.
  
• Buddy taping allows ongoing stretch at the damaged structures.
• Extending the PIPJ following volar plate injury (+/- avulsion) will continue to pull the damaged ligament apart and not enable healing. In a similar way, if the joint is straightened the bone fragment is pulled away from the remaining bone- and healing will be delayed.
  
• Delayed healing may result in chronic instability and development of swan neck deformities.

 We treat volar plate injuries (+/- avulsion) in an extension blocking splint. This allows for full early bending, but limits the risky extended movement. The splint can be gradually straightened as deemed clinically safe to do so.

Footy code (locally) enables play when plastic splint is fully covered with tape- we will usually have a splint for sport and another for the rest of the time.     
                                                                                                     
We are encouraging early referral so we can get them moving within safe limits immediately. Whilst enabling repair and preventing deformity.