A 28-year-old cricketer is struck on the tip of his right ring finger by a ball. He has pain and swelling over the dorsum of the distal interphalangeal joint and cannot actively extend the distal phalanx, though passive extension is full. X-ray shows no fracture. The most appropriate initial treatment is:

• A Continuous extension splinting of the distal interphalangeal joint for 6 to 8 weeks ✓
• B Immediate surgical repair of the terminal extensor tendon
• C Kirschner wire fixation of the distal interphalangeal joint in flexion
• D Shortening splinting of the finger followed by early mobilisation

Explanation

This is a mallet finger caused by closed rupture of the terminal extensor tendon at its insertion into the base of the distal phalanx, without fracture. The standard treatment is continuous extension splinting of the DIP joint alone for 6 to 8 weeks, keeping the joint extended even during splint changes. Surgery is reserved for large bony mallet fragments involving significant articular surface, failed splinting, or open injuries. Early mobilisation would convert a partial tear into a complete one.

Reference: Green's Operative Hand Surgery, 7th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.