Mallet Finger

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Mallet Finger

Authors, Editors, Case Information Author: Jaime Dougherty, BS Affiliation: Rowan-Viruta School of Osteopathic Medicine Co Author(s): Altamash Raja, DO, RMSK, CSCS Senior Editor: Laura Mattson, DO Senior Editor: Joshua Romero, MD Clinical Vignette: A 34-year-old male presented with 4 days of pain and swelling over the distal aspect of the 4th left digit following an injury during a flag football game. He endorsed the inability to extend his distal interphalangeal joint. Type of Probe Used: Linear transducer 15-4 MHz and 19-5 MHz #1 - Video View Video Unlabeled Video of the Left 4th DIP Joint in Long Axis #2 - Video View Video Unlabeled Video of the Left 4th DIP Joint in Short Axis Unlabeled Left 4th DIP Joint Long axis Unlabeled Avulsion Fracture of Left 4th DIP Joint Left 4th DIP Joint Long Axis Unlabeled Left 4th DIP Joint with Doppler Labeled 4th DIP Joint with Doppler Unlabeled Left 4th DIP Joint Short Axis Labeled 4th DIP Joint Short Axis Interpretation Image Interpretation: The proximal portion of the distal phalanx at the distal interphalangeal joint was avulsed off the base of the distal phalanx. The fragment was displaced 0.8 cm proximally with an intact extensor digitorum tendon attaching to the avulsed fragment. No hyperemia or soft tissue swelling was noted. No obvious disruption of the extensor tendon fibers. A 0.8 cm avulsion fracture at the 4th distal interphalangeal joint (Bony Mallet) Teaching Pearl: Ultrasound is a highly accurate diagnostic tool for the evaluation of small, superficial structures in the finger. Studies show it to be more sensitive in showing bony fragments when compared to MRI. Additional evaluation to dynamically assess the function of the extensor tendon is made possible by ultrasound. In the case of a mallet finger, point-of-care ultrasound can be critical in earlier diagnosis with high accuracy and intervention. Two variations of this pathology include bony vs nonbony injury. Bony mallet finger includes extensor tendon injury with avulsion at the base of the distal phalanx. Whereas a non-bony injury may show extensor tendon injury with normal bony anatomy. Conservative treatment includes 6-8 weeks of splinting of the DIP in constant extension. Nocturnal splinting and appropriate rehab may be utilized following this period. Surgical indications include volar subluxation of the distal phalanx and relative indications include greater than 50% of articular surface involved, greater than 2mm articular gap, and open injuries. Wang T, Qi H, Teng J, Wang Z, Zhao B. The Role of High Frequency Ultrasonography in Diagnosis of Acute Closed Mallet Finger Injury. Sci Rep. 2017;7(1):11049. Published 2017 Sep 8. doi:10.1038/s41598-017-10959-x Lin JS, Samora JB. Surgical and Nonsurgical Management of Mallet Finger: A Systematic Review. J Hand Surg Am. 2018;43(2):146-163.e2. doi:10.1016/j.jhsa.2017.10.004
NOTE: For more information, please contact the AMSSM, 4000 W. 114th Street, Suite 100, Leawood, KS 66211 (913) 327-1415.

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Phone: 913.327.1415

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Authors, Editors, Case Information

#1 - Video

#2 - Video

Unlabeled Left 4th DIP Joint Long axis

Unlabeled Avulsion Fracture of Left 4th DIP Joint

Left 4th DIP Joint Long Axis

Unlabeled Left 4th DIP Joint with Doppler

Labeled 4th DIP Joint with Doppler

Unlabeled Left 4th DIP Joint Short Axis

Labeled 4th DIP Joint Short Axis

Interpretation

UPCOMING EVENTS

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