Davos Courses

Executive Editor: Chris Colton

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

Thumb - Distal phalanx: Base - palmar 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.

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

Contraindications

  • Unstable joint after reduction
  • Open fractures
K-wire fixation
Main indication Skill Equipment
Joint instability, disruption of the flexor tendon insertion, small bony fragment Basic surgical experience, no specialized skills Basic equipment only

Contraindications

  • Major soft tissue defect
  • Low functional demand patient
Suture fixation
Main indication Skill Equipment
Disruption of flexor tendon insertion, small bony fragment Basic surgical experience, no specialized skills Basic equipment only

Contraindications

  • Major soft tissue defect
  • Low functional demand patient
Lag screw fixation
Main indication Skill Equipment
Palmar subluxation of the DIP joint, open fractures, bony fragment large enough for screw fixation Some specialized surgical experience Simple surgical and imaging resources

Contraindications

  • Major wound contamination
*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

v1.0 2008-11-08