Serious, often subtle, finger injuries: avoiding diagnosis and treatment pitfalls

Three common finger injuries-proximal interphalangeal (PIP) injuries, mallet finger, and skier's thumb-present unique diagnostic and treatment challenges. Careful history-taking and physical examination are, of course, essential for diagnosing these injuries, but appropriate x-rays are often pivotal. For PIP joint dislocations and fracture-dislocations, extension block splinting is often appropriate, but surgery may be required for an unstable injury. Most mallet finger injuries can be treated with a Stack splint, but functional deformity may necessitate surgery. Skier's thumb can be a bony or ligamentous injury; to avoid fragment displacement, radiographs should be obtained before stressing the joint. Treatment includes a thumb spica cast for a nondisplaced fracture or stable joint, referral for a displaced fracture, and surgery for an unstable joint.