Fingertip Injuries (EMRAP JUNE 2016)

how do you get boutoniere?

Boutonnière deformity is generally caused by a forceful blow to the top (dorsal) side of a bent (flexed) middle joint of a finger. It also can be caused by a cut on the top of the finger, which can sever the central slip (tendon) from its attachment to the bone. The tear looks like a buttonhole ("boutonnière" in French). In some cases, the bone actually can pop through the opening.

what about older injuries that present several days or weeks after injury?

These patients will sometimes present with distant injuries. Is it worth attempting splinting if the injuryis a month old? Yes. The longer it has been out, the longer it needs to be splinted. If a patient presents 4 weeks after their injury, they need to be splinted for 8-20 weeks.

How long to splint? Complications of splinting?

You need to educate patients that they need to maintain constant splinting. If they take off the splint, they must not flex their finger. If they flex their finger, the clock restarts at time zero. These patients are splinted in extension for 6-8 weeks on average.

how to splint?

double ring splint ideal If the patient presents with a swan neck deformity, you should immobilize bothnthe DIP and PIP joints in fullnextension

what is the injury

jersey finger

finer points of exam?

look at distal PIP flexion ability

what will you find on physical exam?

poor cascade

how to treat?

splint in extension

what is the deformity?

swan neck