Rosh Emergency Medicine Practice Test

For a finger injury resulting in inability to actively extend the distal interphalangeal joint, what is the most appropriate treatment?

1. Occupational therapy for range of motion exercises

2. Splinting of the distal interphalangeal joint in hyperextension

3. Surgery to fuse the joint in a functional position

4. Surgery to repair the extensor digitorum tendon

The correct answer is: Splinting of the distal interphalangeal joint in hyperextension

In cases of finger injuries where there is an inability to actively extend the distal interphalangeal (DIP) joint, the most appropriate treatment involves splinting the joint in hyperextension. This approach is aimed at managing conditions such as a mallet finger, where the extensor tendon is either avulsed or ruptured, leading to the inability to extend the finger at the DIP joint. Splinting in hyperextension helps to keep the tendon in a position that promotes healing and allows the injury to recover properly. This conservative method is often effective if implemented early and can prevent complications such as joint stiffness and deformity. The splint typically immobilizes the finger in an extended position, which helps to restore the function of the extensor tendon over time. While the other options may seem relevant in specific circumstances, they do not provide the immediate and appropriate management needed for this type of injury. For instance, occupational therapy might be considered later in the rehabilitation phase, but it won't address the acute issue at hand. Surgical options, such as tendon repair or joint fusion, are more invasive and not the first-line approach for managing simple extensor tendon injuries. Therefore, splinting in hyperextension is the most appropriate and effective treatment for the inability