FINGER INJURY - FOOTBALL

Abstract

300 HISTORY: 17 year old left-handed caucasian high-school football linebacker“jammed” his left ring finger under the shoulder pad of an opponent. While blocking his opponent, the player had his finger extended at the PIP joint and flexed at the DIP when the injury occurred. He felt a“pop”, but had no pain. After noticing blood coming from his left ring finger, he removed himself from the game. PHYSICAL EXAMINATION: On the sidelines, the left ring finger had a 1 cm laceration across the dorsal surface 3-4 millimeters distal to the DIP joint. The nail base was completely avulsed. The extensor tendon was not adequately visualized within the wound. A mallet finger deformity with approximately 25° flexion was noted. He was unable to move the DIP joint; however, PIP and MCP joint motion was normal. On passive ROM, the distal phalanx could be extended only to 15 ° flexion. Laxity of the DIP joint on varus and valgus stress was noted. The affected finger had normal sensation and capillary refill. The rest of the hand examination was unremarkable. DIFFERENTIAL DIAGNOSIS: Avulsion of nail base. Avulsion of extensor tendon, with DIP joint capsule disruption. Epiphyseal fracture of distal phalanx. Fracture of distal phalanx. Laceration with open fracture. Dislocation of DIP. TESTS AND RESULTS: X-rays of the left fourth finger show a transverse fracture through the base of the distal phalanx with dorsal displacement and volar tilting. There is a non-displaced fracture line extending proximally into the joint. WORKING DIAGNOSIS Compound fracture of distal phalanx of left ring finger, with avulsion of the nail base. PLAN/TREATMENT: The patient was removed from competition. The finger was cleansed; a splint, sterile dressing and ice were applied. The patient was sent for orthopedic consultation. A hand specialist surgically reduced the fracture and restored the nail base to anatomic position. Post-operatively, the third and fourth fingers were splinted in partial flexion. The player was held from practice until pain free. Two weeks after surgery, the patient returned to play with a splint. Following the season, the affected finger had normal function.