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Introduction
Introduction
- Terminal extensor tendon mechanism is disrupted at the base of the distal phalanx (1)
- Presents with “dropped finger” appearance
- Injury most commonly occurs in the work environment or during sport participation
- Symptoms usually include painful and swollen DIPJ
- Doley's classification is used to grade the mallet fractures.(2)
Assessment
Assessment
- When taking a referral or describing it on the phone classify as:
- closed or open
- bone or soft tissue (lateral XR will be needed to prove this)
- Examination usually reveals:
- Fingertip would usually rest at 45 degrees and active DIP extension would be lost.
- Hand XR (3)
- AP, lateral and oblique
management (4)
management (4)
- Remove jewellery
- If passively correctable
- SPLINT and repeat lateral XR
- Mallet or Zimmer (keeps PIPJ free) splint
- A mallet splint should immobilise the DIPJ in slight extension
- SPLINT and repeat lateral XR
- Discuss with senior and book appointment with hand therapists.
- likely will have a thermoplastic (TP) splint.
References
References
1. Vannabouathong C, Ayeni OR, Bhandari M. A Narrative Review on Avulsion Fractures of the Upper and Lower Limbs. Clin Med Insights Arthritis Musculoskelet Disord. 2018;11:1179544118809050. 2. Chiu TW. Stone’s Plastic Surgery Facts: A Revision Guide, Fourth Edition. CRC Press; 2018. 3. Green DP, Wolfe SW. Green’s operative hand surgery. Elsevier/Churchill Livingstone; 2011. 4. The British Society of Surgery for the Hand. Hand Injury Triage App [Internet]. [cited 2020 Feb 2]. Available from: handinjurytriageapp.bssh.ac.uk
Image References:Header: Licensed with Adobe Stock 2019Doley's Classification table: Made by Viktorija Kaminskaite for PlasticSurgerySHO"Mallet Injury" Image Reference: Licensed under the Creative Commons Attribution-Share Alike 4.0 International license.
Image References:Header: Licensed with Adobe Stock 2019Doley's Classification table: Made by Viktorija Kaminskaite for PlasticSurgerySHO"Mallet Injury" Image Reference: Licensed under the Creative Commons Attribution-Share Alike 4.0 International license.
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