Hand Case 4 ED Management

Injuries involving less than 25% of the articular surface can be immobilized with the DIP in slight hyperextension for 6-8 weeks for tendinous injuries, 4-5 weeks for bony injuries. The splint can be placed on the dorsal or volar surface of the DIP joint with the other joints left mobile. Patients should follow up with a hand specialist within one week of initial splinting to ensure that the joint is being maintained in extension.

Definitive management is controversial when >25% of the articular surface is fractured. Often initial management is conservative with splinting since complications of open treatment are frequent. However, operative management is an option for mallet injuries accompanied by volar subluxation of the distal phalanx to restore joint alignment and the balance between flexor and extensor forces. ED management should be splinting in slight hyperextension with rapid follow-up with the hand specialist.