Hi, I'm an ortho resident, got a question regarding a patient I saw in the ED, which I'm not quite sure how to manage.
Middle aged male, pounched a wall with clenched fist (Right hand, right handed) 2 hrs ago. Has pain upon flexion of 3rd MP joint, where is extensor tendon dislocates laterally. When the patient extends the MP joint, the tendon pops back in place, and the pain subsides.
Otherwise no complaints. Hand in normal apparence, no swelling / redness / discoloration. Full strength, including 3rd MP flexion. No severe direct and indirect tenderness.
We decided to place a ulnar gutter cast extending to middle finger where the MP joints are kept in full extension. PIP and DIP joints are free. Casted for 3 weeks, then follow up in clinic.
How do you guys usually manage this kind of injury in your insitution? I couldn't find any info about this in Handbook of Fracture and my attending couldn't give a satisfactory answer. Dunno if cast is the proper management especially that pain is the only complaint, with normal function.
Is there any long term sequelae if extensor tendon dislocation become chronic? If not, then cast is properly unnecessary?
References appreciated.
