Test on Extensor Tendon Injuries of the Hand

Question 1: For Type IV (Mallet Fractures) with volar subluxation, the author exclusively recommends nonoperative splint treatment, avoiding Kirschner wire fixation.

A. Ano

B. Ne

Explanation: The author states for Type IV (Mallet Fractures) that 'Unless volar subluxation is present, extension splinting for 5 to 6 weeks is my treatment of choice. I currently recommend treating large fragments associated with volar subluxation with extension block pinning as described previously...' Extension block pinning is a Kirschner wire fixation technique.

Question 2: Which of the following statements is true regarding the management of mallet fractures in children (Seymour's fracture)?

A. These fractures are typically articular, similar to adult mallet fractures.

B. The recommended treatment involves fixing the fracture with a longitudinal Kirschner wire spanning the DIP joint.

C. Vigilance is required for the frequent open nature of this injury, often with an avulsed nail plate.

D. Antibiotic coverage is unnecessary if the injury appears closed upon initial assessment.

Explanation: Mallet fractures in children are transepiphyseal rather than articular, making the first option incorrect. The study materials state that fixing the fracture with a longitudinal Kirschner wire spanning the DIP joint is recommended. It also highlights the frequent open nature of this injury, often with the nail plate avulsed, and warns that failure to recognize this and treat with appropriate irrigation and antibiotic coverage can lead to osteomyelitis.

Question 3: In Zone 3 central slip lacerations, complete transection of the central slip warrants open repair.

A. Ano

B. Ne

Explanation: The study materials state that complete transection of the central slip warrants open repair for Zone 3 injuries.

Question 4: What is the recommended surgical technique for repairing sagittal band lacerations if there is evidence of extensor digitorum communis (EDC) subluxation?

A. Direct repair with a pull-out wire or suture anchor

B. Simple sutures of 4-0 or 5-0, potentially supplemented with a cross-stitch

C. Reattachment to bone using a suture anchor or bone tunnel

D. Immobilization with an MP joint extension casting for 4 weeks

Explanation: The study materials state that "Repair of the sagittal band may be performed with simple sutures of 4-0 or 5-0 (with or without a cross-stitch) if there is evidence of EDC subluxation." The other options describe techniques for other types of tendon injuries or are not applicable to sagittal band lacerations as described in the provided text.

Question 5: For late-presenting open mallet thumb injuries (1 to 2 weeks postinjury), surgical repair is always mandatory, regardless of patient refusal.

A. Ano

B. Ne

Explanation: The study materials state that several cases with late presentation of open mallet thumb injuries (1 to 2 weeks postinjury) have been successfully treated with a splinting protocol in patients who refused surgical repair.