Avulsion fractures happen when a bone fractures/breaks and a ligament or tendon that is attached TO THE BONE pulls a fragment of the bone (usually away from the fracture area).
Normally avulsion fractures heals without the need for any orthopedic surgeries, as long as the bone is pretty much stable and near the original fracture area and the bone fragment doesn't get/cut into into of the nearby structures.
Avulsion fractures becomes more complex and serious when there are additionally other injuries such as nearby tendons or ligaments getting damaged due to the sharp bony fragments lacerating/cutting it...and in such cases, invasive orthopedic surgeries may be required to either remove or stabilize the bony fragment to the fracture location to prevent ongoing/future damage to other structures.
Orthopedic surgical intervention will more likely be required in children who sustain avulsion fractures especially when these fractures are near or on growth plates; because we dont want their growth to be affected, or even worse, uneven (uninjured side grows normally and injured side faster/slower).
Following an avulsion fracture, one will almost always need physiotherapy and hand therapy.
If it's a small and simple fracture, therapy will more likely comprise of
If it's a complex avulsion with surgical intervention, the above still applies, but what's different is:
Therapy is always gentle, and used with cold therapy and pain killers to decrease the swelling and pain to ensure it's comfortable (too rough therapy can aggravate swelling and stiffness and outcomes).
Once the avulsion facture is stabilize, patients will be placed under more active hand therapy and physiotherapy exercise and mobilization including AROM (active range of motion) exercises, scar treatment and management, edema and swelling management, strengthening, work hardening etc.