Picture Quiz

A footballer’s finger injury

BMJ 2013; 347 doi: http://dx.doi.org/10.1136/bmj.f5069 (Published 15 August 2013)
Cite this as: BMJ 2013;347:f5069

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  1. Stephen J Goldie, specialist trainee registrar, plastic surgery12,
  2. Harry W Sargeant, foundation year 2 trainee12,
  3. Karima Medjoub, specialist trainee registrar, plastic surgery12,
  4. Philippa Rust, consultant, orthopaedic hand surgery2,
  5. William Anderson, consultant, plastic surgery12
  1. 1Department of Plastic Surgery, Royal Hospital for Sick Children, Edinburgh EH9 1LF, UK
  2. 2Department of Plastic Surgery, St Johns Hospital, Livingston, UK
  1. Correspondence to: S J Goldie Stephen_goldie{at}hotmail.com

A 12 year old right hand dominant boy sustained an injury to his left middle finger while playing football. On examination, the base of the nail was displaced superficially to the nail fold, with an apparent mallet deformity. The finger was neurovascularly intact. Pain in the finger restricted movement but the flexor and extensor tendons were thought to be intact. Plain lateral and posteroanterior radiographs (fig 1) of the finger were taken in the emergency department.

Fig 1 Plain lateral (left) and posteroanterior (right) radiographs of the injured left middle finger

The boy was otherwise well and was taking no regular drugs. He had previously sustained several sporting injuries.

Questions

  • 1 What abnormality do the posteroanterior and lateral radiographs show?

  • 2 How would this injury be classified?

  • 3 How should this injury be managed?

  • 4 What are the potential complications of this injury?

Answers

1 What abnormality do the posteroanterior and lateral radiographs show?

Short answer

The radiographs show a displaced transphyseal fracture of the terminal phalanx of the left middle finger.

Long answer

This fracture was first described by Seymour in 1966 as a juxta-epiphyseal fracture of the terminal phalanx of the finger.1 This was the first time that displaced physeal fractures had been mentioned and guidance given on the appropriate treatment. Seymour reported a series of 20 patients treated with reduction of the fracture and replacement of the nail plate under the nail fold to act as a splint. This management led to a more favourable outcome than K wiring.1 A lateral …

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