Orthopaedic Hand Trauma CH32 (1)

326

SECTION 3  | Tendon Injuries

Table 32.2  Doyle Classification Type I

Closed injury with or without small dorsal avulsion fracture

Type II Type III Type IV

Open injury (laceration)

Open injury (deep soft tissue abrasion involving skin and tendon substance)

Mallet fracture Distal phalanx physeal injury (pediatrics) Fracture involving 20–50% of the articular surface Fracture involving greater than 50% of the articular surface

● ● Most commonly used splints include ( Figure 32.6 ) ◆ ◆ Prefabricated, molded polyethylene (Stack) splint ◆ ◆ Custom, thermoplastic Stack splint ◆ ◆ Abouna splint ● ● A residual extensor lag may persist at cessation of closed treatment (although it is typically less than 10°). ■ ■ Operative —Most authors agree that the classification of the lesion is the most important indicating factor for surgical management. Patient demographics, history on presentation, time since the injury, and the degree of extension deficit are also commonly used to determine need for surgical intervention. ● ● Absolute indications ◆ ◆ Volar subluxation of the distal phalanx ◆ ◆ Inability to tolerate splinting ● ● Relative indications ◆ ◆ More than 50% of the articular surface is involved. ◆ ◆ More than a 2-mm articular gap ● ● Contraindications ◆ ◆ Simple, closed mallet finger injuries

Figure 32.6  Different splint types. A, alumifoam extension splint. B, molded plastic stack splint. C, oval-8 finger splint.

Made with FlippingBook HTML5