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Extension splinting of DIP joint for 6-8 weeks
91%
6377/7034
Closed reduction and percutaneous pinning
7%
461/7034
Open reduction and internal fixation
2%
128/7034
DIP arthrodesis
0%
18/7034
Swan neck deformity correction
7/7034
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The clinical presentation is consistent with a non-displaced bony mallet finger without joint subluxation. Extension splinting of the DIP joint for 6-8 weeks is the most appropriate treatment. A mallet finger is a deformity caused by disruption of the terminal extensor tendon distal to DIP joint. Treatment is dictated by the degree of displacement and acuity of injury. Acute injuries with minimal displacement and no joint subluxation are treated with extension bracing for 6-8 weeks. ORIF or closed reduction and percutaneous fixation is indicated for chronic injuries or acute injuries with volar displacement of the distal phalanx, a >2mm articular step-off, or when a majority (>50%) of the articular surface is involved. Pegoli et al. report the results of extension block Kirschner wire fixation for the treatment of mallet fractures of the distal phalanx in 65 consecutive patients. Their results showed 46% excellent, 32% good, 20% fair and 2% poor results. The recommend the following indications for operative treatment: presence of a large bone fragment, palmar subluxation, or the loss of joint congruity of the distal interphalangeal joint. Theivendran et al. report operative fixation is indicated when more than 30% of the articular surface is involved with or without subluxation of the joint. They summarize the management options for intra-articular distal interphalangeal fractures, placing particular emphasis on surgical treatment. Figure A shows a non-displaced bony mallet Injury. Illustration A shows an example of an extension splint used for non-operative management of mallet injuries. Illustration V is a video showing the surgical technique for a Mallet finger. Incorrect Answers: Answer 2: Closed reduction and percutaneous pinning is indicated for a displaced mallet finger injury with joint subluxation. Answer 3: Open reduction and internal fixation is indicated for displaced, subluxed mallet finger injuries that can not be reduced closed. Answer 4: DIP arthrodesis is indicated in patients with a painful, stiff, arthritic DIP joint. Answer 5: Swan neck deformity correction is indicated for a chronic mallet finger that has led to a swan neck deformity.
4.1
(16)
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