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9.27 Extensor Tendon Avulsion - Distal Phalanx (Baseball or Mallet Finger)


Presentation

There is a history of a sudden resisted flexion of the distal interphalangeal (DIP) joint, such as when the finger tip is jammed or struck by a ball, resulting in pain and tender ecchymotic discoloration over the dorsum of the base of the distal phalanx. When the finger is held in extension the injured DIP joint remains in slight flexion.

What to do:

What not to do:

Discussion

Adequate splinting usually restores full range and strength to DIP joint extension, but the patient will require 6 weeks of immobilization, and should be informed that healing might be inadequate, requiring surgical repair. A wide variety of splints are commercially available for splinting this injury (e.g. Stack, "frog") but, in a pinch, a tape-covered paper clip will do. A dorsal splint allows more use of the finger, but requires more padding and may contribute to ischemia of the skin overlying the DIP joint.

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from Buttaravoli & Stair: COMMON SIMPLE EMERGENCIES
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Craig Feied, MD
Mark Smith, MD
Jon Handler, MD
Michael Gillam, MD