MALLET FINGER

MALLET FINGER

Q. 1 The patient is unable actively to extend the terminal phalange although the distal interphalangeal joint can be extended passively. This is known as-

 A Mallet finger

 B

Trigger finger

 C

Butter finger

 D

Ring finger 

Q. 1

The patient is unable actively to extend the terminal phalange although the distal interphalangeal joint can be extended passively. This is known as-

 A

Mallet finger

 B

Trigger finger

 C

Butter finger

 D

Ring finger 

Ans. A

Explanation:

In medicine, mallet finger, also baseball finger, dropped finger and (more generally) extensor tendon injury, is an injury of the extensor digitorum tendon of the fingers at the distal interphalangeal joint (DIP). It results from hyperflexion of the extensor digitorum tendon, and usually occurs when a ball (such as a softball, basketball, or volleyball), while being caught, hits an outstretched finger and jams it – creating a ruptured or stretched extensor digitorum tendon. Treatment options include surgery or putting the finger in a Mallet splint for 6 to 8 weeks or extension block k-wire for 4 weeks. The splint allows the tendon to return to normal length, if the finger is bent during these weeks the healing process must start all over again. Surgery is used to reattach the tendon and is usually performed within a week of the injury.


Q. 2 Mallet finger’ is a common traumatic lesion resulting in flexion deformity of distal interphalangeal joint.
The basic pathology of this condition is
 A Avulsion fracture of middle phalanx
 B Rupture of collateral slips of extensor expansion
 C Rupture of central slip of extensor expansion
 D Dislocation of distal interphalangeal joint
Ans. B

Explanation:

Rupture of collateral slips of extensor expansion

Mallet  finger’ describes the characteristic drooping of the finger observed with injury to the extensor digitorum at

its insertion at the base of the distal  phalanx (the collateral  slips).

o A mallet finger may result from direct trauma  to the finger tip or more commonly, by forcibly bending the finger in extension,  for example, when catching a ball – hence,  the synonym, ‘baseball finger.”

o In older patients, the associated trauma may be minor for example, catching the tip  of the finger whilst changing the sheets on the bed.

o The extensor mechanism is disrupted. The finger is held flexed at the distal interphalangeal joint. There is no active movement but passive movement is unimpaired. In time, the proximal phalanx may become hyperextended.

o An x-ray should be obtained to look for any associated chip fracture.

o Most injuries are treated conservatively. A mallet finger splint is applied to hold the distal interphalangeal extended whilst permitting movement at the proximal interphalangeal joint.

o If conservative treatment fails then part of the tendon is excised over the terminal phalanx and the joint held extended with aKirschner wire.

o Extensor expansion (dorsal expansion, dorsal hood) refers to the flattened tendons (aponeurosis) of extensor muscles that run into the back of the hand.

o At the distal end of the metacarpal, the extensor tendon will expand  to form a hood, which covers the back and sides of the head of the metacarpal  and the proximal phalanx.

o The expansion soon divides into three bands:

* Two lateral  bands pass on either side of the proximal  phalanx and stretch all the way to the distal  phalanx. The lumbricals of the hand, the palmar & dorsal interossei  of the hand, also insert on these bands.

* A single median band passes down the middle  of the finger along the back of the proximal phalanx, ending at the base of the middle  phalanx


Q. 3

Avulsion of extensor tendon give rise to?

 A

Mallet finger

 B

Dupuytren’s contracture

 C

Trigger finger

 D

Swan neck deformity

Ans. A

Explanation:

It is the flexion deformity of the distal interphalangeal joint usually due to avulsion of extensor tendon of distal phalanx.

 

 

 

Ref: Current Diagnosis & Treatment in Orthopedics 3/e, page 538,564-65.

 


Q. 4

Which among the following is TRUE regarding mallet finger?

 A

Avulsion of tendon at the base of the middle phalanx

 B

Avulsion of extensor tendon at the base of the distal phalanx

 C

Fracture of distal phalanx

 D

Fracture of the proximal phalanx

Ans. B

Explanation:

Ans.B
The mallet finger deformity is characterized by a loss of full active distal interphalangeal joint extension with full passive Range Of Motion evident.
The mallet finger reflects the loss of normal extensor force transmission via the terminal tendon insertion onto the distal phalanx.
The unopposed flexor digitorum profundus pulls the distal joint into flexion.  
The usual mechanism of injury involves sudden passive flexion of the actively extended distal interphalangeal joint.
Disruption of the terminal tendon may be entirely confined to the tendon or may involve an avulsed fracture fragment from the dorsal lip of the distal phalanx proximal articular surface.
 
Ref: Bednar M.S., Light T.R. (2006). Chapter 10. Hand Surgery. In H.B. Skinner (Ed), CURRENT Diagnosis & Treatment in Orthopedics, 4e. 

Q. 5

Mallet finger is

 A

Avulsion fracture of extensor tendon of distal phalanx

 B

Fracture of distal phalanx

 C

Fracture of middle phalanx

 D

Fracture of proximal phalanx

Ans. A

Explanation:

A i.e. Avulsion fracture of extensor tendon of distal phalanx


Q. 6

Iniury shown in the photograph is ? 

 A

Rolando fracture.

 B

Kaplan lesion.

 C

Mallet finger.

 D

Jersey finger.

Ans. C

Explanation:

Mallet finger is an injury to the thin tendon that straightens the end joint of a finger or thumb. Although it is also known as “baseball finger,” this injury can happen to anyone when an unyielding object (like a ball) strikes the tip of a finger or thumb and forces it to bend further than it is intended to go. As a result, you are not able to straighten the tip of your finger or thumb on your own.


Q. 7

Identify the orthopaedic splint as shown in the picture below ? 

 A

Mallet finger splint.

 B

Radial finger splint.

 C

Ulnar splint.

 D

Volar splint.

Ans. A

Explanation:

The splint shown in the picture above represents Mallet finger splint.

MALLET FINGER SPLINTS

Common Uses. Avulsion of the extensor tendon from the base of the distal phalanx (with or without an avulsion fracture).

Application. The DIP joint is placed in slight hyperextension with a padded dorsal splint, an unpadded volar splint, or a prefabricated mallet finger splint. Continuous extension in the splint for six to eight weeks is essential, even when changing the splint. Compliance is assessed every two weeks. Night splinting for an additional two to three weeks is recommended.



Q. 8

Identify this condition:

 A

Dupuytren’s contracture


 B Trigger Finger

 C

Mallet Finger

 D

Swan neck deformity

Ans. C

Explanation:

Ans:C.)Mallet Finger.

MALLET FINGER

A finger deformity caused by disruption of the terminal extensor tendon distal to DIP joint: the disruption may be bony or tendinous

Also known as baseball finger, dropped finger, dolphin finger.

Treatment

Nonoperative

extension splinting of DIP joint for 6-8 weeks

Operative

Closed Reduction and Percutaneous Pin Fixation /Open Reduction & Internal Fixation Surgery /surgical reconstruction of terminal tendon/DIP arthrodesis



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