Best Practice Case Studies-Case 129 Asset 3 Finger Injuries

Video Transcription

Video Summary

The lecture, led by Dr. Jeff Leggett, reviewed common finger injuries in athletes and how to diagnose and manage them, with an emphasis on ultrasound, exam maneuvers, and when to refer to hand surgery.

He first covered <strong>mallet finger</strong>, caused by disruption of the distal extensor mechanism at the DIP joint. This can be purely tendinous or involve an avulsion fracture. Diagnosis is based on inability to actively extend the DIP, often confirmed with ultrasound and X-ray. Treatment is <strong>continuous DIP extension splinting for 6–8 weeks</strong>, followed by protection during activity. Large fractures, volar subluxation, open injuries, or failed conservative care warrant surgical referral.

Next he discussed <strong>boutonniere deformity</strong>, a late complication of a missed <strong>central slip injury</strong>. He reviewed the <strong>Elson test</strong> and explained that treatment is <strong>PIP extension splinting for 6 weeks</strong>, then buddy taping. Significant avulsion fractures or established deformity should be referred.

He then described <strong>jersey finger</strong>, an avulsion of the flexor digitorum profundus, which causes inability to flex the DIP. Because flexor tendon injuries need prompt repair, these should be <strong>splinted in flexion and referred urgently to surgery</strong>.

Other topics included <strong>volar plate injuries</strong> from hyperextension, <strong>collateral ligament injuries</strong> from side-to-side stress, <strong>trigger finger</strong> (stenosing tenosynovitis) and its ultrasound-guided steroid or percutaneous treatment, <strong>pulley ruptures/bowstringing</strong> in climbers, and pediatric injuries like <strong>Seymour fractures</strong> and <strong>Salter-Harris fractures</strong>, which require X-ray and often surgery.

Overall, the key message was: examine carefully, use ultrasound and X-ray wisely, splint appropriately, and refer unstable or complex injuries early.

Meta Tag

Edition 4th Edition

Related Case 4th Edition, Case 129

Topic Hand

Keywords

4th Edition

4th Edition, Case 129

Hand

mallet finger

boutonniere deformity

jersey finger

central slip injury

Elson test

ultrasound diagnosis

DIP extension splinting

PIP extension splinting

hand surgery referral

Seymour fracture