A cricketer jams his right little finger while catching a ball. The distal interphalangeal joint rests in flexion and he cannot actively extend it. X-ray shows an avulsion fragment involving slightly less than one third of the articular surface of the distal phalanx, with no volar subluxation of the phalanx. The best initial treatment is:

• A Arthrodesis of the distal interphalangeal joint
• B Open reduction and internal fixation with a pull-out wire
• C Kirschner wire fixation of the DIP joint in full flexion
• D Extension splinting of the DIP joint continuously for six to eight weeks ✓

Explanation

Mallet finger is an avulsion of the terminal extensor tendon, with or without a bony fragment. Closed injuries with a small fragment and a congruent, non-subluxated DIP joint heal reliably with continuous extension splinting of the DIP joint alone for six to eight weeks, leaving the PIP joint free. Operative fixation is reserved for large fragments involving roughly half the articular surface, or any injury with volar subluxation of the distal phalanx, which signals joint incongruity.

Reference: Rockwood and Green's Fractures in Adults, 9th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.