Pediatric emergency medicine trisk 3347 3347
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Mallet finger injuries are avulsion fractures of the distal phalanx that
commonly result from a finger jam mechanism. In adolescents, the injury is often
seen on a lateral radiograph ( Fig. 109.7 ). A similar tendon avulsion in a younger
child might not have an associated fracture. Mallet finger injuries are managed in
an extension splint. In the emergency room setting, AlumaFoam and stack splints
may be utilized. However, providers should be mindful of appropriate sizing, as
splints designed for adults commonly do not fit. Many of these injuries are treated
with immobilization alone. Even large fragments may not require surgical care,
however all mallet finger injuries should be referred to a hand specialist.
FIGURE 109.6 Seymour fracture. A : Lateral radiograph depicting a displaced distal
phalangeal physeal fracture in the setting of a nail bed injury. B : Intraoperative photograph
after nail plate removal depicting the tear in the germinal matrix of the nail bed and underlying
bony injury. (Courtesy of Children’s Orthopaedic Surgery Foundation.)
Jersey finger injuries refer to traumatic avulsion of the flexor digitorum
profundus tendon at the level of the distal phalanx. These commonly occur when
the finger is held in flexion and then sustains forceful extension, for example,
when a football player is attempting to tackle another player with their fingers.
There is often pain on the volar aspect of the finger, with the affected finger held
in slight extension ( Figs. 109.2 and 109.8 ); the patient cannot actively flex the
DIP joint. These injuries commonly occur without an associated fracture but
require urgent referral to a hand specialist for operative repair.
