9.27 Extensor Tendon Avulsion of Distal Phalanx
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(Baseball or Mallet Finger)
agk's Library of Common Simple Emergencies

Presentation
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There is a history of a sudden resisted flexion 
of the distal interphalangeal (DIP) joint, such 
as when the finger tip is jammed or struck by a 
ball, resulting in pain and tender ecchymotic 
discoloration over the dorsum of the base of 
the distal phalanx. When the finger is held in 
extension the injured DIP joint remains in 
slight flexion.

What to do:
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- Instruct the patient to keep the splint in 
    place continuously and seek orthopedic 
    followup care within one week.
- Prescrlbe an analgesic as needed.

What not to do:
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- Do not assume there is no significant injury 
    just because the x ray is negative. With or 
    without a fracture the tendon avulsion 
    requires splinting.
- Do not forcefully hyperextend the joint. This 
    can result in ischemia and skin breakdown 
    over the joint.

Discussion
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Adequate splinting usually restores full range 
and strength to DIP joint extension, but the 
patient will require 6 weeks of immobilization, 
and should be informed that healing might be 
inadequate, requiring surgical repair. A wide 
variety of splints are commercially available 
for splinting this injury (e.g. Stack, "frog") 
but, in a pinch, a tape-covered paper clip will 
do. A dorsal splint allows more use of the 
finger, but requires more padding and may 
contribute to ischemia of the skin overlying 
the DIP joint.

Illustration
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img/cse0927.gif

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 from Buttaravoli & Stair: COMMON SIMPLE EMERGENCIES
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