Executive Editor: Chris Colton

Authors: Fiesky Nuñez, Renato Fricker, Matej Kastelec, Terry Axelrod

Distal phalanx - Proximal, dorsal avulsion

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Glossary

General considerations

Discontinuities of the extensor insertion are often referred to as “mallet injury” or “baseball finger”. They can be purely tendinous or bony avulsion fractures.

The injuries can result in subluxation or total dislocation of the joint.

Large fragment remains minimally displaced because of the volar plate attachment, the collateral ligament, and the IV annular pulley.

An avulsion injury destroys the synergistic balance of the pull exerted by flexor and extensor tendons. The continuity of the flexor tendon is lost. This results in inability to flex the DIP joint.

Nonoperative treatment
Main indication Skill Equipment
Stable joint after reduction, minimal fragment displacement Basic surgical experience, no specialized skills Basic equipment only

Contraindications

  • Unstable joint after reduction
  • Open fractures
K-wire immobilization
Main indication Skill Equipment
Palmar subluxation of the DIP joint, very small dorsal fragment, open fractures Some specialized surgical experience Basic equipment only
Lag screw fixation
Main indication Skill Equipment
Palmar subluxation of the DIP joint, moderate to large size dorsal fragment, open fractures Some specialized surgical experience Simple surgical and imaging resources

Contraindications

  • Major soft tissue disruption
Tension-band wire
Main indication Skill Equipment
Palmar subluxation of the DIP joint, moderate size dorsal fragment, open fractures Some specialized surgical experience Basic equipment only

Contraindications

  • Major soft tissue disruption
K-wire fixation
Main indication Skill Equipment
Palmar subluxation of the DIP joint, fragment large enough for K-wire fixation, open fractures Some specialized surgical experience Basic equipment only
*Skill
Basic surgical experience, no specialized skills Basic surgical experience, no specialized skills
Some specialized surgical experience Some specialized surgical experience
Highly experienced and skilled surgeon Highly experienced and skilled surgeon
*Equipment
Basic equipment only Basic equipment only
Simple surgical and imaging resources Simple surgical and imaging resources
Full specialized surgical and imaging resources Full specialized surgical and imaging resources

v2.0 2016-06.30