0071643192.pdf

ORTHOPEDICS

If the FDS is cut, the patient

can still flex both the DIP and

PIP joint.

An untreated mallet finger can

result in a swan-neck

deformity.

■ Absolute contraindications to reimplantation: Unstable patient or severe

crush injury

FRACTURES OFDIGITS

■ Fractures of digits are most often stable and nondisplaced. Treat with buddy

taping.

■ Unstable fractures and intra-articular fractures of digits should be reduced

and splinted and will often require internal fixation.

FLEXORTENDONINJURIES

MECHANISM

■ These injuries are most commonly associated with lacerations of the flexor

digitorum superficialis (FDS) and flexor digitorum profundus (FDP) and

can cause loss of flexion of the PIP and DIP joint. However, if only the

FDS is cut, patients can still flex both joints.

■ Closed injuries are associated with rheumatoid arthritisandathletic injury.

■ Classic athletic injury occurs when a football player grabs another player’s

jersey (thus the term “jersey finger”), avulsing the profundus tendon from

its bony insertion.

TREATMENT

■ Both open and closed injuries usually require surgical repair.

COMPLICATIONS

■ Laceration injuries may cause damage to the digital arteries and nerves.

MALLETFINGER

MECHANISM

Forced flexion of the DIP (“jammed finger”), leading to rupture of the extensor

tendon at its insertion at the base of the distal phalanx or bony avulsion of the

tendon insertion site.

DIAGNOSIS

■ Unable to extend DIP: X-ray may reveal avulsion fracture (see Figure 4.2).

■ Splint DIP in strict extension for 6 to 8 weeks (with a Stack-type splint):

Watch for development of pressure sores!

COMPLICATIONS

■ If untreated, a swan neck deformity (hyperextension of PIP, flexion of

DIP) may result.

BOUTONNIEREDEFORMITY

MECHANISM

■ Forced flexion at PIP, causing tear of the central portion of the extensor

tendon at the PIP joint