Musculoskeletal Injuries 321299.A 35-year-old man presents to the ED with right hand swelling, pain, and
erythema that began 3 days ago. He denies any trauma, sick contacts, insect
bites, or recent travel. The patient’s vitals are significant for an oral temperature
of 101°F. Upon physical examination, you note an area of erythema surround-
ing multiple punctate lacerations over the right third and fourth metacarpopha-
langeal (MCP) joints with localized tenderness. The patient is neurovascularly
intact with limited flexion caused by the swelling and pain. Given the above pre-
sentation, what is the most appropriate disposition for this patient?
a. Suture and close follow-up with a hand surgeon
b. Suture and prescription for oral antibiotics
c. Wound irrigation and prescription for oral antibiotics
d. Wound irrigation and tetanus prophylaxis
e. Admission for intravenous (IV) antibiotics
300.A 23-year-old man presents to the ED complaining of finger pain. He
states that while playing football, he went to catch a pass and the ball hit the
tip of his finger and bent his finger backward. He thinks his finger is just
“jammed.” On examination, you notice that the distal phalanx is flexed and
there is swelling and tenderness over the distal interphalangeal (DIP) joint, as
seen below. In addition, he cannot extend his distal finger at the DIP joint. An
x-ray does not reveal a fracture. Which of the following is the most appro-
priate way to manage this injury?
a. Place a dorsal splint so that the proximal interphalangeal (PIP) and DIP joints
are immobile, remove splint in 1 to 2 weeks.
b. Place a dorsal splint so that the PIP and DIP joints are immobile, remove splint
in 1 week.
c. Buddy tape the finger.
d. Place a dorsal splint to immobilize the DIP joint, remove splint in 1 to 2 weeks.
e. Place a dorsal splint to immobilize the DIP joint, remove splint in 6 to 8 weeks.
(Reproduced, with permission, from Knoop KJ, Stack LB, Storrow AB.Atlas of Emergency
Medicine. New York, NY: McGraw-Hill, 2002: 315.)