probably the most common fracture in man is a bowler plate of ulsan fracture we've all got eight fingers hyperextension injuries are for everybody at some time in their life at some point and the bowler plate always that's not something we can say in
medicine often tears loose from the base of the middle phalanx and it tears loose with or without a small fragment of bone we don't see the great majority of these injuries so that we don't have any idea how many little fractures of the volar
plate occur but one would have to assume that it's probably the most common fracture in man they create a problem for the joint if this is the attachment of the bowler plate which runs down the front it's a thick structure that
doesn't Bend and it slides up and down on the front of the joint and we notice that when we flex the joint down the bowler plate slides down the front of the proximal phalanx so that 100% of the rotation that occurs in the structures
between this middle phalanx and the proximal phalanx occurs right there right where the rover plate attaches it attaches via a sharpie fibers into the base of the bone roll early and when the finger flexes the bowler plate slides
and doesn't Bend the proximal phalanx does its rotation that means all of the rotation takes place right there that requires a highly specialized attachment which is fine and narrow and when this gets ruptured with or without
the little piece of bone it can tear off a little piece of bone or just tear loose and then it heals back on and when it does not unusually you'll have a situation where let's put it in flexion where the bowler plate is healed back on
in a sort of broad attachment of tissue and scar and this does not have the flexibility of the highly localized boilerplate attachment to the volar aspect of the bone and this big ghulami area won't let
the voter plate rotate at this point so it tries to bend and that produces the symptoms as the voter plate has to be forced into flexion which it won't do it wants to sit straight and go up and down and what we do with these is you treat
the initial injury with a splint for two to three weeks and two to three weeks to take it off and let him use it and then we'll leave it alone and watch it for about six months and most of these don't require anything further as as we said
before they they often are not even picked up or seen by a physician they're just a hyper-extended injury the coach pulls the finger snap get back in the game and nobody ever sees it but if it's six months this is still a painful
finger which will have what we call it positive boilerplate tests passive flexion of the middle joint will be painful significantly painful they also often will not flex and if they don't go beyond 90 degrees and they are painful
we will do the following procedure we go in and roll back the bowler plate off its attachment to the base of the middle phalanx so that's the middle phalanx that's the proximal phalanx behind and we'll just detach the bowler plate
across then create a small cancellous groove across the base of the proximal of the middle phalanx notice that we leave the assembly line attachment intact on this side and what that lets you do is mobilize this finger totally
in 48 hours we don't have to wait for a pullout wire or a bony attachment of any structural sort the assembly line is intact on the on the opposite side from which we open it we usually try and choose the side where there's an injury
to the collateral ligament as the side with which to peel the bowler plate back make a small can sell a screw we'll take this and put it back up here and put one little stitch into the assembly line putting the rollerplate back in position
but that is not a stitch that's responsible for maintaining the voter plate from ripping loose that is accomplished by having left the attachment on the assembly line on the opposite side and we take and dress
these and 48 hours later allow full mobilization and that full mobilization on this structure in line with this cancellous groove across the base of the middle phalanx will reestablish an adequate sophisticated structure which
will allow rotation to occur at the proper place at that highly specialized detachment and let the volar plate remain collinear with the proximal phalanx and re-establish a painless finger in a very simple fashion
you
medicine often tears loose from the base of the middle phalanx and it tears loose with or without a small fragment of bone we don't see the great majority of these injuries so that we don't have any idea how many little fractures of the volar
plate occur but one would have to assume that it's probably the most common fracture in man they create a problem for the joint if this is the attachment of the bowler plate which runs down the front it's a thick structure that
doesn't Bend and it slides up and down on the front of the joint and we notice that when we flex the joint down the bowler plate slides down the front of the proximal phalanx so that 100% of the rotation that occurs in the structures
between this middle phalanx and the proximal phalanx occurs right there right where the rover plate attaches it attaches via a sharpie fibers into the base of the bone roll early and when the finger flexes the bowler plate slides
and doesn't Bend the proximal phalanx does its rotation that means all of the rotation takes place right there that requires a highly specialized attachment which is fine and narrow and when this gets ruptured with or without
the little piece of bone it can tear off a little piece of bone or just tear loose and then it heals back on and when it does not unusually you'll have a situation where let's put it in flexion where the bowler plate is healed back on
in a sort of broad attachment of tissue and scar and this does not have the flexibility of the highly localized boilerplate attachment to the volar aspect of the bone and this big ghulami area won't let
the voter plate rotate at this point so it tries to bend and that produces the symptoms as the voter plate has to be forced into flexion which it won't do it wants to sit straight and go up and down and what we do with these is you treat
the initial injury with a splint for two to three weeks and two to three weeks to take it off and let him use it and then we'll leave it alone and watch it for about six months and most of these don't require anything further as as we said
before they they often are not even picked up or seen by a physician they're just a hyper-extended injury the coach pulls the finger snap get back in the game and nobody ever sees it but if it's six months this is still a painful
finger which will have what we call it positive boilerplate tests passive flexion of the middle joint will be painful significantly painful they also often will not flex and if they don't go beyond 90 degrees and they are painful
we will do the following procedure we go in and roll back the bowler plate off its attachment to the base of the middle phalanx so that's the middle phalanx that's the proximal phalanx behind and we'll just detach the bowler plate
across then create a small cancellous groove across the base of the proximal of the middle phalanx notice that we leave the assembly line attachment intact on this side and what that lets you do is mobilize this finger totally
in 48 hours we don't have to wait for a pullout wire or a bony attachment of any structural sort the assembly line is intact on the on the opposite side from which we open it we usually try and choose the side where there's an injury
to the collateral ligament as the side with which to peel the bowler plate back make a small can sell a screw we'll take this and put it back up here and put one little stitch into the assembly line putting the rollerplate back in position
but that is not a stitch that's responsible for maintaining the voter plate from ripping loose that is accomplished by having left the attachment on the assembly line on the opposite side and we take and dress
these and 48 hours later allow full mobilization and that full mobilization on this structure in line with this cancellous groove across the base of the middle phalanx will reestablish an adequate sophisticated structure which
will allow rotation to occur at the proper place at that highly specialized detachment and let the volar plate remain collinear with the proximal phalanx and re-establish a painless finger in a very simple fashion
you
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