A 32-year-old man jams his ring finger playing cricket. He cannot extend the distal interphalangeal joint actively. X-ray shows an avulsion fragment involving 45% of the articular surface of the distal phalanx with volar subluxation of the distal phalanx. The most appropriate management is:
- A Closed reduction and percutaneous Kirschner wire fixation of the fragment ✓
- B Extension splinting of the DIP joint for 6 weeks
- C Arthrodesis of the DIP joint
- D Flexor digitorum profundus advancement
Correct answer: A. Closed reduction and percutaneous Kirschner wire fixation of the fragment
Explanation
This is a bony mallet injury. Pure tendinous mallet fingers are treated with continuous DIP extension splinting for 6 to 8 weeks, but a bony fragment involving more than 30% of the articular surface, especially with volar subluxation of the distal phalanx, requires operative fixation, typically closed reduction with percutaneous pinning. Arthrodesis is reserved for painful post-traumatic arthritis, and FDP surgery addresses flexion, not extension loss.
Reference: Green's Operative Hand Surgery, 7th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.