The Role of High Frequency Ultrasonography in Diagnosis of Acute Closed Mallet Finger Injury

The role of ultrasonography in diagnosing acute closed volar plate injury of proximal interphalangeal joint

BACKGROUND

Acute closed volar plate injury of the proximal interphalangeal joint (PIP) is a common hand injury. In the past, there were few objective evaluation imaging methods for the degree of volar plate injury. The purpose of this study was to investigate the role of high frequency ultrasonography in diagnosing volar plate injury, and to explore whether ultrasound can provide a beneficial guidance to clinical decision-making and appropriate treatment adopting through accurate US classification of volar plate injury.

METHODS

From May 2019 to may 2022, 41 patients diagnosed with volar plate injury were included in this study. All patients underwent ultrasonography and X-ray examinations. The sonographic features were analyzed. A new kind of classification of volar plate injury based on ultrasonography findings was described.

RESULTS

Either an injury of volar plate or an avulsion fracture of middle phalangeal base was identified clearly on ultrasonography, according to which volar plate injury could be divided into three types: A, B and C. Type A, avulsion fracture of the middle phalangeal base without volar plate rupture; Type B, full thickness tear of the volar plate without avulsion fracture; Type C, partial thickness tear of the volar plate. The average thickness of the three types of injured volar plate measured by ultrasound was 0.33 ± 0.05 cm, and the average thickness of the volar plate at the same site of the corresponding finger on the contralateral side was 0.22 ± 0.03 cm. There was significant difference between the two group (t = 11.823, p = 1.2476 *10^(-14)).

CONCLUSIONS

High frequency ultrasonography could be a reliable, accurate, convenient and non-radioactive diagnostic imaging technique in the evaluation of acute closed volar plate injury of PIP. And ultrasound could provide a beneficial guidance to clinical decision-making and appropriate treatment adopting through accurate US classification.

EURO-MUSCULUS/USPRM Dynamic Ultrasound Protocols for Wrist and Hand

ABSTRACT

In this dynamic protocol, ultrasound evaluation of the wrist and hand is described using various maneuvers for relevant conditions. Scanning videos are coupled with real-time patient examination videos. The authors believe that this practical guide - prepared by the international consensus of several experts - will help musculoskeletal physicians perform a better and uniform/standard examination approach.

An overview of mallet finger injuries

Mallet finger describes a fingertip deformity where the distal interphalangeal joint (DIPJ) of the affected digit is held in flexion, unable to extend the distal phalanx actively. The deformity is typically a consequence of traumatic disruption to the terminal extensor tendon at its insertion at the proximal portion of the distal phalanx or slightly proximally at the level of the DIPJ. Patients typically present with a history describing the event of injury with a typical mallet deformity. Common mechanisms include sport activities causing a direct blow to the finger, low energy trauma while performing simple tasks such as pulling up socks or crush injuries from getting the finger trapped in a door. The DIPJ can be passively extended, but this extension of the joint cannot be maintained once the passive extension is stopped. The Doyle classification can be used to categorise and dictate treatment. The extensor lag associated with the deformity does not improve spontaneously without treatment. Inappropriate management can lead to chronic functional loss and stiffness of the finger. The majority of closed mallet splints are Doyle type I, which can be managed non-surgically with external splints, worn full-time to keep the fingertip straight until the tendon injury or fracture heals. Surgical techniques is considered for other types of mallet injuries. Techniques used include closed reduction and Kirschner wire fixation, open reduction and internal fixation, reconstruction of the terminal extensor tendon and correction of swan neck deformity.

Pulley, Flexor, and Extensor Tendon Injuries of the Hand

Tendon injuries represent the second most common injury of the hand (after fractures) and are a common scanning indication in radiology. Pulley injuries are very frequent in rock climbers with the A2 pulley the most commonly affected. Tendon and pulley injuries can be reliably evaluated using ultrasound (US) and magnetic resonance imaging (MRI). US can be postulated as a first-line imaging modality, allowing dynamic examination. MRI is essential for cases with ongoing diagnostic doubt post-US and also for preoperative pulley reconstruction assessment.

Degenerative lesion of the extensor tendon V finger: Ultrasound imaging in diagnosis and therapeutic possibilities

Traumatic injuries of the extensor tendons of the hand are common and are more frequent predisposed to tendon injuries due to the presence of chronic tendon damage. We present the case of a 61-year-old woman, tailor by profession, who showed acute rupture (80 %) with degenerative etiology of the extensor tendon of the V finger of the fifth level according to Kleinert and Verdan classification.

Mallet finger injuries: the signs, symptoms, diagnosis and management

Patients commonly present to UK emergency departments with injuries to the tips of their fingers. Mallet finger is one of the most common injuries, resulting from an injury to the extensor tendon over the dorsal surface of the distal phalanges of the hand. Timely recognition, diagnosis and management are required to prevent complications. This article provides an overview of the pathophysiology, signs, symptoms, diagnosis and management of mallet finger injuries.