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Choi C, Lee SJ, Choo HJ, Lee IS, Kim SK. Avulsion injuries: an update on radiologic findings. Yeungnam Univ J Med 2021; 38:289-307. [PMID: 34411477 PMCID: PMC8688780 DOI: 10.12701/yujm.2021.01102] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Revised: 06/08/2021] [Accepted: 06/22/2021] [Indexed: 11/05/2022] Open
Abstract
Avulsion injuries result from the application of a tensile force to a musculoskeletal unit or ligament. Although injuries tend to occur more commonly in skeletally immature populations due to the weakness of their apophysis, adults may also be subject to avulsion fractures, particularly those with osteoporotic bones. The most common sites of avulsion injuries in adolescents and children are apophyses of the pelvis and knee. In adults, avulsion injuries commonly occur within the tendon due to underlying degeneration or tendinosis. However, any location can be involved in avulsion injuries. Radiography is the first imaging modality to diagnose avulsion injury, although advanced imaging modalities are occasionally required to identify subtle lesions or to fully delineate the extent of the injury. Ultrasonography has a high spatial resolution with a dynamic assessment potential and allows the comparison of a bone avulsion with the opposite side. Computed tomography is more sensitive for depicting a tiny osseous fragment located adjacent to the expected attachment site of a ligament, tendon, or capsule. Moreover, magnetic resonance imaging is the best imaging modality for the evaluation of soft tissue abnormalities, especially the affected muscles, tendons, and ligaments. Acute avulsion injuries usually manifest as avulsed bone fragments. In contrast, chronic injuries can easily mimic other disease processes, such as infections or neoplasms. Therefore, recognizing the vulnerable sites and characteristic imaging features of avulsion fractures would be helpful in ensuring accurate diagnosis and appropriate patient management. To this end, familiarity with musculoskeletal anatomy and mechanism of injury is necessary.
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Affiliation(s)
- Changwon Choi
- Department of Radiology, Inje University Busan Paik Hospital, Inje University College of Medicine, Pusan, Korea
| | - Sun Joo Lee
- Department of Radiology, Inje University Busan Paik Hospital, Inje University College of Medicine, Pusan, Korea
| | - Hye Jung Choo
- Department of Radiology, Inje University Busan Paik Hospital, Inje University College of Medicine, Pusan, Korea
| | - In Sook Lee
- Department of Radiology, Pusan National University Hospital, Pusan, Korea
- Biomedical Research Institute, Pusan National University School of Medicine, Pusan, Korea
| | - Sung Kwan Kim
- Department of Radiology, Pusan Himchan Hospital, Pusan, Korea
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Hölscher L, Lögters T. [Extensor injuries at the zone I of the digits]. Unfallchirurg 2021; 124:258-264. [PMID: 33625530 DOI: 10.1007/s00113-021-00967-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/27/2021] [Indexed: 11/26/2022]
Abstract
Injuries of the extensor tendon in zone I are frequently seen. If detected early and treated appropriately they are associated with good functional results. Open injuries are primarily treated surgically by suturing the injured tendon. Closed injuries without bone involvement are treated conservatively. In cases of bone involvement the treatment procedure is determined by the articulation and the extent of fragment displacement. This article presents the current state of knowledge on the diagnostics and treatment of extensor tendon injuries in zone I with the aim of providing treatment recommendations for the clinical routine.
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Affiliation(s)
- L Hölscher
- Abteilung für Unfall‑, Hand- und Orthopädische Chirurgie, St. Antonius Krankenhaus Köln, Schillerstr. 23, 50968, Köln, Deutschland
| | - T Lögters
- Abteilung für Unfall‑, Hand- und Orthopädische Chirurgie, St. Antonius Krankenhaus Köln, Schillerstr. 23, 50968, Köln, Deutschland.
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Abstract
An athlete's hands are susceptible to a variety of acute and cumulative traumas depending on their chosen sport. Depending on the timing of the injury, the immediate requirements of the athlete, and future aspirations, treatment strategies may need individual customization. This article offers a brief review of the anatomy and complex function of the extensor mechanism, discusses the etiologies of various extensor injuries, and outlines the multiple treatment options and expected outcomes.
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Affiliation(s)
- Spencer Skinner
- Division of Hand Surgery, Department of Orthopedic Surgery, Virginia Commonwealth University Health System, 1200 East Broad Street, PO Box 980153, Richmond, VA 23298, USA
| | - Jonathan Isaacs
- Division of Hand Surgery, Department of Orthopedic Surgery, Virginia Commonwealth University Health System, 1200 East Broad Street, PO Box 980153, Richmond, VA 23298, USA.
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Abstract
Finger injuries are common in athletes playing in professional ball sports. Understanding the intricate anatomy of the digit is necessary to properly diagnose and manage finger injuries. Unrecognized or poorly managed finger injuries can lead to chronic deformities that can affect an athlete's performance. Multiple factors and treatment options should be considered to provide the best functional outcome and rapid return to play for an athlete. This article discusses the mechanism of injury, diagnosis, treatment, and return-to-play recommendations for common finger injuries in ball sports.
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Affiliation(s)
- David T Netscher
- Division of Plastic Surgery, Department of Orthopedic Surgery, Baylor College of Medicine, 6624 Fannin Street, Suite 2730, Houston, TX 77030, USA.
| | - Dang T Pham
- Department of Surgery, Houston Methodist Hospital, Weill Medical College of Cornell University, 6550 Fannin Street, Smith Tower 1661, Houston, TX 77030, USA
| | - Kimberly Goldie Staines
- Department of Physical Medicine and Rehabilitation, Michael E. DeBakey Veterans Affairs Medical Center, 2002 Holcombe Boulevard, RCL117, Houston, TX 77030, USA
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Avery DM, Rodner CM, Edgar CM. Sports-related wrist and hand injuries: a review. J Orthop Surg Res 2016; 11:99. [PMID: 27633260 PMCID: PMC5025579 DOI: 10.1186/s13018-016-0432-8] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2016] [Accepted: 08/28/2016] [Indexed: 12/15/2022] Open
Abstract
Background Hand and wrist injuries are common during athletics and can have a significant impact especially if initially disregarded. Due to their high level of physical demand, athletes represent a unique subset of the population. Main body The following is an overview of hand and wrist injuries commonly seen in athletics. Information regarding evaluation, diagnosis, conservative measures, and surgical treatment are provided. Conclusion Knowledge of these entities and special consideration for the athlete can help the team physician effectively treat these players and help them achieve their goals.
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Affiliation(s)
- Daniel M Avery
- University of Connecticut Musculoskeletal Institute, 263 Farmington Avenue, Farmington, CT, 06030-4037, USA.
| | - Craig M Rodner
- University of Connecticut Musculoskeletal Institute, 263 Farmington Avenue, Farmington, CT, 06030-4037, USA
| | - Cory M Edgar
- University of Connecticut Musculoskeletal Institute, 263 Farmington Avenue, Farmington, CT, 06030-4037, USA
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Read PJ, Morrison WB. Imaging Injuries in Throwing Sports Beyond the Typical Shoulder and Elbow Pathologies. Radiol Clin North Am 2016; 54:857-64. [PMID: 27545424 DOI: 10.1016/j.rcl.2016.05.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
This review article describes injuries that occur in the upper extremities of athletes less commonly than those typically discussed with shoulders and elbows. A survey of osseous, musculotendinous, ligamentous, and neurovascular injuries is presented along with associated imaging findings and standard treatment options. This article does not focus on the classic throwing injuries of the shoulder or elbow; the goal is to survey injuries in throwing sports that involve structures away from the glenohumeral, acromioclavicular, or elbow joints. The goal of this article is to introduce readers to these less common injuries, describe their clinical presentations, and characterize their typical imaging appearances.
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Affiliation(s)
- Paul J Read
- Division of Musculoskeletal Radiology and Interventions, Department of Radiology, Thomas Jefferson University Hospital, 132 South 10th Street, Philadelphia, PA 19107, USA.
| | - William B Morrison
- Division of Musculoskeletal Radiology and Interventions, Department of Radiology, Thomas Jefferson University Hospital, 132 South 10th Street, Philadelphia, PA 19107, USA
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Conservative treatment of mallet finger: A systematic review. J Hand Ther 2016; 28:237-45; quiz 246. [PMID: 26003015 DOI: 10.1016/j.jht.2015.03.001] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2014] [Revised: 02/28/2015] [Accepted: 03/03/2015] [Indexed: 02/03/2023]
Abstract
PURPOSE To determine if there is a superior orthosis and wearing regimen for the conservative treatment of mallet finger injuries. The secondary purpose is to examine the current evidence to evaluate if a night orthosis is necessary following the initial immobilization phase. METHODS A comprehensive literature search was conducted using the search terms mallet finger, splint, orthosis, and conservative treatment. RESULTS Four randomized controlled trials (RCTs) were included in the systematic review. In all 4 RCTs mallet fingers were immobilized continuously for 6 weeks in acute injuries and 8 weeks for chronic injuries. CONCLUSIONS Two of the three studies found a large effect size for orthotic intervention ranging from 2.17 to 12.12. Increased edema and age and decreased patient adherence seem to negatively influence DIP extension gains. Recommended immobilization duration is between 6 to 8 weeks and with additional weeks of immobilization in cases of persistent lags. LEVEL OF EVIDENCE 1a.
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Abstract
Extensor mechanism injuries are frequently encountered in athletes and can lead to permanent disability or deformity if not promptly and properly treated. This article reviews basic anatomy, and then discusses mallet finger injuries, boutonniere deformity, and sagittal band rupture. Once treatment has begun, return to sport is highly variable because of the varied needs of each athlete and where they fall on the spectrum of disease. As such, each athlete must be carefully evaluated and closely followed to ensure a safe, prompt, and judicious return to athletic pursuits.
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Affiliation(s)
- John T McMurtry
- Department of Orthopaedic Surgery, Virginia Commonwealth University Health System, 1200 East Broad Street, 9th Floor East Wing, Richmond, VA 23298, USA
| | - Jonathan Isaacs
- Division of Hand Surgery, Department of Orthopaedic Surgery, Virginia Commonwealth University Health System, 1200 East Broad Street, 9th Floor East Wing, Richmond, VA 23298, USA.
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Asano K, Inoue G, Shin M. TREATMENT OF CHRONIC MALLET FRACTURES USING EXTENSION-BLOCK KIRSCHNER WIRE. ACTA ACUST UNITED AC 2014; 19:399-403. [DOI: 10.1142/s0218810414500348] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Eleven patients with chronic mallet fractures that were seen later than four weeks after injury were treated by extension-block Kirschner wire technique. The average duration from injury to operative treatment was 56 days (range, 28–111). The follow-up evaluations took place after a mean of eight months. The radiographic bone union was obtained in all patients. The average extension loss of the DIP joint was 4 degree (range, 0–15) and the average flexion was 68 degree (range, 43–90). The results according to Crawford's criteria were six excellent, two good, two fair, and one poor. We would say that the technique we treated is effective method of treatment for younger patients with chronic mallet fractures.
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Affiliation(s)
- Kenichi Asano
- Department of Orthopaedic Surgery, Hamamatsu Medical Center, Shizuoka 432-8580, Japan
| | - Goro Inoue
- Department of Orthopaedic Surgery, Seiyukai Ezaki Hospital, Aichi 440-0883, Japan
| | - Masaki Shin
- Department of Orthopaedic Surgery, Toyohashi Municipal Hospital, Aichi 441-8570, Japan
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Abstract
Mallet finger is a common injury involving either an extensor tendon rupture at its insertion or an avulsion fracture involving the insertion of the terminal extensor tendon. It is usually caused by a forceful blow to the tip of the finger causing sudden flexion or a hyperextension injury. Fracture at the dorsal aspect of the base of the distal phalanx is commonly associated with palmar subluxation of the distal phalanx. Most mallet finger injuries are recommended to be treated with immobilisation of the distal interphalangeal joint in extension by splints. There is no consensus on the type of splint and the duration of use. Most studies have shown comparable results with different splints. Surgical fixation is still indicated in certain conditions such as open injuries, avulsion fracture involving at least one third of the articular surface with or without palmar subluxation of the distal phalanx and also failed splinting treatment.
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Affiliation(s)
- Jason Pui Yin Cheung
- Department of Orthopaedics and Traumatology, University of Hong Kong Medical Centre, Queen Mary Hospital, Hong Kong
| | - Boris Fung
- Department of Orthopaedics and Traumatology, University of Hong Kong Medical Centre, Queen Mary Hospital, Hong Kong
| | - Wing Yuk Ip
- Department of Orthopaedics and Traumatology, University of Hong Kong Medical Centre, Queen Mary Hospital, Hong Kong
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Minchin P, Spirtos M. Investigation of the conservative management of mallet injury in Irish acute hospitals. HAND THERAPY 2012. [DOI: 10.1258/ht.2012.012004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Introduction Mallet injury is a commonly treated hand injury in acute hospitals. While there is much literature regarding the various treatment options and outcomes, no studies were found that describe the management of this injury across a national health service. This study describes how mallet injury is managed within the acute hospital system in Ireland. An understanding of the current system of service provision is essential for future service development in this area. Method Emergency and occupational therapy departments in the 29 acute case-mix hospitals in Ireland were contacted by telephone and postal questionnaire with 47 respondents participating in the study. Descriptive statistics are used to present the results. Results Results indicate that accessing acute hospital-based services for the conservative management of mallet injury typically follows a predictable pathway, but can result in delays and disruption to treatment for the patient. There is little evidence of direct referral from the emergency department to the occupational therapist which, when compared with published literature, would represent the most efficient and optimum care pathway for the patient. The choice of splint used by both the emergency and occupational therapy departments differs, but treatment provided is in line with available evidence-based practice. Conclusions This preliminary study provides a basis for future service development in the acute management of mallet injury, by describing how treatment is currently provided nationally. Recommendations for further investigation have been made, and the need for audit and outcome measurement has been highlighted. The development of therapy-led services in Ireland is proposed, to improve efficiency and quality of service provision in the conservative management of mallet injury.
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Affiliation(s)
- Paula Minchin
- Occupational Therapy Department, Adelaide & Meath Hospital, Dublin, Ireland
| | - Michelle Spirtos
- Discipline of Occupational Therapy, Trinity College, Dublin, Ireland
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Abstract
BACKGROUND Mallet finger is a common injury. The aim of this review is to give an overview of the different treatment options of mallet injuries and their indications, outcomes, and potential complications. METHODS A literature-based study was conducted using the PubMed database comprising world literature from January of 1980 until January of 2010. The following search terms were used: "mallet" and "finger." RESULTS There are many variations in the design of splints; there are, however, only a few studies that compare the type of splints with one another. Splinting appears to be effective in uncomplicated and complicated cases. Equal results have been reported for early and delayed splinting therapy. To internally fixate a mallet finger, many different techniques have been reported; however, none of these studies examined their comparisons in a controlled setting. In chronic mallet injuries, a tenodermodesis followed by splinting or a tenotomy of the central slip is usually performed. If pain and impairment persist despite previous surgical corrective attempts, an arthrodesis of the distal interphalangeal joint should be performed. CONCLUSIONS Uncomplicated cases of mallet injuries are best treated by splinting therapy; cases that do not react to splinting therapy are best treated by surgical interventions. Controversy remains about whether mallet injuries with a larger dislocated bone fragment are best treated by surgery or by external splinting.
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Sports Related Hand Injuries in Hong Kong. Hong Kong J Occup Ther 2010. [DOI: 10.1016/s1569-18611070053-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Hart RG, Kleinert HE, Lyons K. The Kleinert modified dorsal finger splint for mallet finger fracture. Am J Emerg Med 2005; 23:145-8. [PMID: 15765333 DOI: 10.1016/j.ajem.2004.05.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Injuries to the hand and digits are commonly seen in the emergency department. Lacerations, contusions, puncture wounds, and fractures comprise the bulk of these injuries. A fracture to the dorsum of the distal phalanx can result in a mallet finger deformity. These fractures must be accurately diagnosed with the proper initial treatment begun. There is some disagreement over the best treatment approach and multiple different splints have been described in the literature. Conservative treatment with a finger splint is most commonly effective. We recommend a modified dorsal finger splint for these injuries. We describe a splint to properly treat the fracture, prevent complications, maximize patient comfort during rehabilitation, and prevent mallet finger deformity.
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Affiliation(s)
- Raymond G Hart
- Department of Emergency Medicine, University of Louisville School of Medicine, KY 40202, USA.
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