01Approach to the Critical Patient/attcp47

Alarm features requiring immediate action

›Vascular compromise indicators

›Pale or dusky fingertip

›Capillary refill > 2 seconds

›Digital artery injury concern

›Complete neurovascular deficit

›Absent two-point discrimination

›Pulseless digit

›If vascular compromise present, emergent hand surgery consultation

›Revascularization window < 6 hours

›Operative exploration required

›Open injury indicators

›Open dislocation or fracture

›Wound overlying PIP or DIP joint

›Tendon visible or extruding

›Open tendon laceration

›Extensor tendon disruption

›Flexor tendon disruption

›If open injury, emergent hand surgery consultation

›Wound irrigation and temporary dressing

›Tetanus prophylaxis if not up to date

›Irreducible dislocation

›Failed closed reduction after digital block

›Interposed soft tissue obstruction

›Bony block on radiograph

›If irreducible, urgent operative reduction required

›Hand surgery notification

›Avoid repeated reduction attempts

02History/hx59

Mechanism and onset

›Injury mechanism

›Forced hyperextension of PIP joint

›Ball striking fingertip (basketball, volleyball, cricket)

›Fall on outstretched hand

›Forced DIP flexion (mallet mechanism)

›Terminal extensor tendon avulsion

›Axial load to extended fingertip

›Axial compression

›Direct crush injury

›Industrial machinery

›Timing and progression

›Acute onset at time of injury

›Hours since injury

›Whether deformity was immediate

›Delayed or progressive deformity

›Days to weeks after initially dismissed "jammed finger"

›Gradual loss of PIP flexion arc

Symptoms

›Pain characterization

›Pain location

›PIP joint pain (volar plate or collateral ligament)

›DIP joint pain (mallet finger component)

›Functional limitation

›Inability to flex PIP fully

›Difficulty gripping objects

›Snapping or catching sensation during finger flexion

›Neurological symptoms

03Physical Exam/exam62

Inspection and deformity assessment

›Classic deformity pattern

›PIP joint hyperextension

›Degree of hyperextension in resting posture

›Passive correctable versus fixed

›DIP joint flexion

›Unable to actively extend DIP (mallet component)

›DIP drop angle measurement

›MCP joint position

›MCP flexion with PIP hyperextension suggests intrinsic tightness

›Soft tissue findings

›Swelling and ecchymosis

›PIP joint swelling

›DIP joint swelling

›Skin integrity

›Open wound overlying joint

›Subungual hematoma (nail bed injury)

Palpation

›Tenderness localization

›Volar PIP joint

›Volar plate tenderness at proximal middle phalanx

›Collateral ligament origin tenderness

›Dorsal DIP joint

›Extensor tendon insertion tenderness (mallet)

›Avulsion fragment tenderness

›Entire finger neurovascular assessment

›Two-point discrimination (normal < 6 mm)

›Capillary refill (normal < 2 seconds)

04Differential Diagnosis/ddx57

Primary traumatic diagnoses

›Mallet finger (Zone I extensor injury)

›ICD-10: S63.22 — traumatic rupture of extensor tendon at DIP level

›DIP flexion deformity only without initial PIP hyperextension

›If untreated, secondary swan neck deformity develops over weeks to months

›Differentiating features

›Isolated DIP drop without PIP hyperextension in acute phase

›Dorsal DIP tenderness at extensor insertion

›PIP joint dorsal dislocation

›ICD-10: S63.28 — dislocation of interphalangeal joint of finger

›Gross deformity with complete joint incongruency

›Often precursor event to swan neck deformity if volar plate tears

›Differentiating features

›Apparent on inspection; confirmed radiographically

›Swan neck develops as sequela if volar plate not healed

›Volar plate injury without established deformity

›ICD-10: S63.68 — sprain of interphalangeal joint of finger

›Hyperextension injury with volar PIP tenderness

›No deformity yet but risk of progressive swan neck

›Differentiating features

›No resting PIP hyperextension posture

›Stress test reveals laxity

Deformity mimics

›Boutonniere deformity

›ICD-10: M20.02 — boutonniere deformity of finger

›PIP flexion with DIP hyperextension — opposite pattern to swan neck

›Central slip disruption at PIP dorsal surface

›Differentiating features

05Laboratory Tests/lt35

Routine labs (rarely indicated for isolated injury)

›Complete blood count

›Indication

›Pre-operative workup if surgical intervention planned

›Concern for open fracture with significant blood loss

›Interpretation

›Leukocytosis may indicate superimposed infection if delayed presentation

›Thrombocytopenia relevant if anticoagulation planned

Inflammatory markers

›Erythrocyte sedimentation rate and C-reactive protein

›Indication

›Inflammatory etiology suspected rather than pure trauma

›Bilateral or atypical presentation

›Interpretation

›Elevated ESR > 40 mm/hour raises rheumatoid concern

›Elevated CRP supports systemic inflammatory disease

›Rheumatoid factor and anti-CCP antibodies

›Indication

›No clear traumatic mechanism

›Multiple joint involvement

›Interpretation

›Anti-CCP sensitivity 67% and specificity 95% for rheumatoid arthritis

›Positive results redirect to rheumatology rather than hand surgery

›Uric acid

›Indication

›Atypical acute monoarthritis of PIP or DIP

›No trauma mechanism

›Interpretation

06Diagnostic Tests/dt103

Scoring Systems

›Nalebuff classification of swan neck deformity (staging)

›Type I

›Flexible deformity with full PIP flexion in all MCP positions

›Conservative management appropriate

›Type II

›PIP flexion limited in certain MCP positions (intrinsic tightness present)

›Intrinsic release or splinting required

›Type III

›PIP flexion limited in all positions but articular surface preserved

›Surgical soft tissue reconstruction indicated

›Type IV

›Fixed deformity with articular destruction

›Joint arthroplasty or arthrodesis required

›PIP joint stability grading

›Grade I

›Stable with < 20% articular surface fracture

›Conservative management appropriate

›Grade II

›20-40% articular surface fracture with maintained congruency

›Close follow-up and possible extension-block splinting

›Grade III

›> 40% articular surface fracture or joint subluxation

›Operative intervention required

›Strickland scoring for tendon function

›Excellent: Total active motion > 150 degrees

›Near-complete functional recovery

›Good: Total active motion 125-150 degrees

›Adequate for most activities of daily living

›Fair: Total active motion 90-124 degrees

›Occupational therapy optimization indicated

›Poor: Total active motion < 90 degrees

›Surgical revision consideration

MRI

›Indications for MRI of the finger

›Diagnostic uncertainty after radiograph and clinical exam

›Suspected occult tendon injury not visualized on ultrasound

›Complex soft tissue injury requiring surgical planning

›Pre-operative evaluation for reconstruction

›FDS tendon integrity before tenodesis planning

›Lateral band and oblique retinacular ligament assessment

›MRI findings in swan neck deformity

›Volar plate

›Disruption appearing as T2 hyperintense signal at PIP volar surface

›Proximal or distal avulsion pattern visible

›Terminal extensor tendon (mallet component)

›Discontinuity at distal phalanx dorsal insertion

›Bony avulsion fragment may be present

›Lateral bands

›Dorsal subluxation of lateral bands in established deformity

›T2 signal change indicating scarring or chronic injury

›MRI protocol considerations

›Dedicated finger coil preferred for resolution

›1.5 Tesla minimum; 3 Tesla preferred for small structures

›Axial, sagittal, and coronal sequences required

›Limitations

›Motion artifact common in acute painful injury

›Cost and availability limit routine use in ED

CT

›Indications for CT of the finger

›Complex articular fracture assessment

›Comminuted intra-articular fracture not fully characterized on plain radiograph

›Pre-operative planning for fracture-dislocation

›Suspected occult fracture

›High clinical suspicion with negative plain radiograph

›Pilon fracture of middle phalanx assessment

›CT findings relevant to swan neck deformity

›Volar lip fracture of middle phalanx

›Articular surface percentage involvement quantified

›Fragment size and displacement measured

›Dorsal avulsion at distal phalanx base

›Fragment size relative to articular surface

›Displacement > 2 mm indicates bony mallet requiring splinting or fixation

›Joint congruency

›Subluxation detected on CT even when radiograph appears aligned

›Multiplanar reconstruction essential

›CT protocol

›Thin-slice (0.5-1 mm) with multiplanar reconstruction

›Coronal, sagittal, and axial reconstructions

›Three-dimensional rendering for surgical planning

›No intravenous contrast required for bony assessment

›Contrast adds value only if vascular injury suspected

Ultrasound

›Point-of-care ultrasound indications

›Bedside extensor tendon integrity assessment

›Dynamic evaluation of terminal extensor tendon at DIP

›Volar plate integrity at PIP joint

›Joint effusion confirmation

›Hemarthrosis versus effusion distinction

›Aspiration guidance if indicated

›Ultrasound findings in swan neck deformity

›Terminal extensor tendon

›Discontinuity at DIP dorsal surface indicates complete rupture

›Hypoechoic gap at insertion site

›Volar plate at PIP

›Echogenic fibrocartilaginous structure at PIP volar surface

›Disruption appears as irregular echogenicity with joint laxity on dynamic exam

›Lateral band position

›Dorsal subluxation of lateral bands visible with dynamic PIP flexion

›Normal lateral bands move volarly with PIP flexion

›Ultrasound technique

›High-frequency linear probe (15-18 MHz) required

›Small parts preset

›Liberal gel and water-bath technique for near-field resolution

›Dynamic examination essential

›Assess tendon integrity with active and passive motion

›Compare with contralateral finger

07Disposition/dispo52

Discharge criteria

›Criteria for ED discharge

›Joint congruency confirmed post-reduction

›Post-reduction radiograph showing concentrically reduced PIP or DIP

›No articular incongruency or subluxation

›Adequate pain control achieved

›Oral analgesics sufficient

›Digital block wearing off with tolerable baseline pain

›Appropriate splint applied and patient instructed

›Correct splint type for injury mechanism

›Patient demonstrates understanding of splint care

›Reliable follow-up confirmed

›Appointment within 1-2 weeks for splint check and repeat radiograph

›Contact number for hand surgery if problems arise

Admission and observation indications

›Indications for inpatient or observation admission

›Open fracture-dislocation requiring operative debridement

›Operative wound management cannot be deferred

›Antibiotic coverage initiated in ED

›Polytrauma context

›Finger injury as part of multi-system trauma

›Admission driven by other injuries

›Failed closed reduction requiring operative reduction

›OR booking required

›NPO status initiated

Hand surgery referral thresholds

›Emergent referral (same-day operative)

›Open injury with tendon laceration

08Treatment/t118

Analgesia

›Systemic analgesia

›NSAIDs first-line for acute pain

›Ibuprofen 400-600 mg PO every 6-8 hours with food

›Maximum 2400 mg/day

›Avoid if renal impairment or gastric ulcer history

›Naproxen 500 mg PO twice daily

›Maximum 1000 mg/day

›Superior duration of action compared to ibuprofen

›Acetaminophen as adjunct

›500-1000 mg PO every 6-8 hours

›Maximum 4000 mg/day

›Reduce to 2000 mg/day in hepatic impairment

›Avoid opioids for isolated finger injury

›Reserve for polytrauma context or operative patients

›Regional anesthesia

›Digital nerve block

›1% lidocaine without epinephrine (traditional technique)

›2 mL per digital nerve (radial and ulnar sides)

›Onset 5-10 minutes

›Lidocaine with epinephrine acceptable per current evidence

›No increased risk of digital ischemia demonstrated in multiple studies

›Prolonged duration of anesthesia benefit

›Hematoma block for bony injuries

›2-3 mL directly into fracture hematoma

›Onset 5 minutes

Wound care and tetanus prophylaxis

›Open wound management

›Irrigation with normal saline

›High-pressure irrigation for contaminated wounds

›Volume proportional to contamination level

›Tetanus prophylaxis

›Td booster if last immunization > 5 years ago

›0.5 mL IM deltoid

›TIG 250 units IM if uncertain immunization status or high-risk wound

›Give at separate site from Td

Reduction technique

›Closed reduction of PIP dorsal dislocation

›Digital block first

›Adequate anesthesia before manipulation

›Confirm anesthesia onset before proceeding

›Technique

›Longitudinal traction applied to finger

›Gentle hyperextension to disengage volar lip

›Flex PIP joint while maintaining traction

›Palpable or audible click at reduction

›Assess stability through range of motion after reduction

›Post-reduction assessment

›Active ROM to assess stability arc

›Extension-block splint at 20-30 degrees PIP flexion

Splinting protocols

›Mallet finger splinting (DIP component)

›Stack splint (DIP extension splint)

›DIP held in full extension or slight hyperextension (5 degrees)

›Continuous 24-hour wear for minimum 6-8 weeks

›Even brief flexion resets the treatment clock

›Splint must maintain DIP extension while PIP is mobile

›Verify splint does not restrict PIP flexion

›Skin inspection at every visit for maceration or pressure sores

›Bony mallet (avulsion < 30% articular surface, joint congruent)

›Same DIP extension splinting protocol

›Surgery not required if joint remains concentric

›Volar plate injury splinting

›Dorsal extension-block splint

›PIP blocked at 20-30 degrees flexion for 2-3 weeks

›Prevents hyperextension recurrence

›Allows early active PIP flexion

›Progressive splint extension after 2-3 weeks

›Advance 10 degrees per week toward full extension

›Hand therapy guidance recommended

›PIP hyperextension blocking splint

›Oval-8 ring splint or figure-of-eight splint

›Prevents PIP hyperextension while allowing flexion

›Worn continuously for 6-8 weeks for mobile deformity

›Night splinting continued for additional 4-6 weeks

›Sizing critical for effectiveness

›Too loose loses blocking function

›Too tight risks vascular compromise

›Buddy taping as adjunct

›3-6 weeks for stable injuries

›Adjacent finger provides lateral support during rehabilitation

Surgical management

›Indications for operative intervention

›Failed conservative management after 8-12 weeks

›Persistent mobile deformity despite compliant splinting

›FDS tenodesis (superficialis sling) first-line surgical option

›Fixed PIP hyperextension not correctable by splinting

›Lateral band translocation (Zancolli-Tonkin procedure)

›Lateral bands relocated volarly to PIP axis

›8-year follow-up data show durable correction in 41-digit series

›Fracture > 30% articular surface or joint subluxation

›ORIF or volar plate arthroplasty

›Dynamic external fixation for comminuted fracture-dislocations

›Surgical options by severity

›Soft tissue reconstruction (Nalebuff Type I-III)

›FDS tenodesis (superficialis sling)

›FDS slip detached and rerouted to prevent PIP hyperextension

›Preserves PIP motion while blocking extension past neutral

›Lateral band translocation

›Indicated when intrinsic tightness contributes

›Lateral bands repositioned volar to PIP axis

›Volar plate advancement

›For isolated volar plate attenuation

›Dermadesis

›Skin tethering procedure for mild flexible deformity

›Joint salvage or replacement (Nalebuff Type IV)

›PIP joint arthroplasty

›Silicone or surface-replacement implant

›Appropriate when articular cartilage destroyed

›PIP arthrodesis

›Fusion in functional position (25-40 degrees flexion)

›Indicated when arthroplasty not appropriate

Post-reduction and post-operative medications

›Antibiotic prophylaxis

›Open injuries

›First-generation cephalosporin (cephalexin 500 mg PO QID x 5 days)

›Covers Staphylococcus aureus and Streptococcus species

›Clindamycin 300 mg PO QID x 5 days if penicillin allergy

›Prophylaxis not indicated for closed injuries

›Closed fractures or dislocations without open wound

›Corticosteroid injection contraindication

›Avoid corticosteroid injection into acutely injured tendons

›Risk of tendon weakening and rupture

›No evidence of benefit in acute traumatic swan neck

09Special Populations/sp102

Pregnancy

›Physiologic considerations

›Joint laxity increased in pregnancy

›Relaxin-mediated ligament laxity increases volar plate vulnerability

›Increased risk of recurrent instability after reduction

›Edema considerations

›Physiologic pregnancy edema may mask injury severity

›Splints require more frequent adjustment as edema fluctuates

›Medication safety in pregnancy

›Analgesic selection

›Acetaminophen preferred first-line analgesic in all trimesters

›500-1000 mg PO every 6-8 hours, maximum 4000 mg/day

›NSAIDs use in pregnancy

›Avoid after 20 weeks gestation (premature ductus arteriosus closure risk)

›First trimester use controversial; limit to < 30 weeks if essential

›Avoid opioids unless no alternative

›Neonatal abstinence syndrome risk with chronic use

›Local anesthesia for digital block

›Lidocaine category B in pregnancy

›Short-acting local anesthetic safe for single-dose use

›Avoid epinephrine-containing formulations if vasoconstriction concern exists

›Imaging considerations in pregnancy

›Plain radiograph of finger

›Acceptable with abdominal shielding

›Radiation dose to finger is negligible to fetus

›MRI preferred over CT for soft tissue assessment

›No ionizing radiation

›First trimester: avoid gadolinium unless essential

›Surgical timing in pregnancy

›Defer elective surgery until postpartum if possible

›Second trimester safest window if surgery cannot be deferred

›Regional block preferred over general anesthesia

Geriatric

›Age-related physiologic considerations

›Reduced tissue healing capacity

›Prolonged splinting duration may be required

›Lower threshold for hand therapy involvement

›Skin fragility

›Splint-related pressure sores and maceration more common

›More frequent splint checks (weekly rather than biweekly)

›Bone quality

›Osteoporosis increases fracture severity

›Articular fracture more likely in low-energy mechanisms

›Comorbidity considerations

›Diabetes mellitus

›Impaired soft tissue and tendon healing

›Higher infection risk if open wound

›Glycemic optimization important (target HbA1c < 8%)

›Anticoagulation

›Warfarin, DOAC, or antiplatelet therapy increases hematoma formation

›Splinting tight enough to cause vascular compromise risk increased

›Cognitive impairment

›Compliance with continuous mallet splinting difficult

›Caregiver instruction essential

›Lower threshold for supervised hand therapy

›Medication adjustments

›NSAID caution in elderly

›Increased GI bleeding risk: use with proton pump inhibitor

›Renal function decline with chronic NSAID use

›Avoid in eGFR < 30 mL/min/1.73m2

›Acetaminophen preferred

›Reduce maximum daily dose to 2000 mg/day in frailty

›Monitor for hepatic impairment

Pediatrics

›Age-specific injury patterns

›Physeal injuries more common than tendon avulsions in children

›Growth plate (physis) is the weak point before tendon insertion

›Salter-Harris classification applies to phalangeal fractures

›Mallet finger in children

›Often Salter-Harris Type I or II physeal fracture at DIP

›Conservative splinting effective in most cases

›Pure tendon avulsion less common than in adults

›Volar plate injuries less common in children

›Volar plate avulsion fractures from middle phalanx base

›Open physis near injury site requires radiologic expertise

›Growth plate considerations

›Salter-Harris classification for phalangeal physeal injuries

›Type I: Physeal separation without fracture

›Type II: Fracture through physis with metaphyseal fragment (most common)

›Type III: Fracture through physis into epiphysis (articular)

›Type IV: Fracture through physis, epiphysis, and metaphysis (highest risk of growth arrest)

›Risk of physeal arrest

›Type III and IV injuries carry risk of digit shortening or angular deformity

›Orthopedic or hand surgery consultation for Type III and IV injuries

›Pediatric medication dosing

›Ibuprofen

›5-10 mg/kg PO every 6-8 hours

›Maximum single dose 400 mg

›Maximum daily dose 40 mg/kg/day up to 1200 mg/day

›Acetaminophen

›15 mg/kg PO every 4-6 hours

›Maximum single dose 1000 mg

›Maximum daily dose 75 mg/kg/day up to 4000 mg/day

›Lidocaine for digital block in children

›1% lidocaine without epinephrine

›Maximum dose 4.5 mg/kg (7 mg/kg with epinephrine)

›Volume in small fingers: 0.5-1 mL per nerve

›Pediatric splinting

›Stack splint for mallet finger

›6-8 weeks continuous wear as in adults

›Parental supervision of splint compliance essential

›Skin inspection at every visit; children have thinner skin

›Buddy taping preferred for stable PIP injuries in young children

›Better tolerated than formal splinting

›3-4 weeks duration

10Background/b86

Epidemiology

›Prevalence and incidence

›Swan neck deformity from trauma

›Most common traumatic precursor is untreated mallet finger

›Secondary swan neck develops in up to 50% of untreated mallet fingers

›Population distribution

›Ball-handling sport athletes disproportionately affected

›Basketball, volleyball, football, cricket highest incidence sports

›Manual laborers and industrial workers at elevated risk

›Sex and age distribution

›Traumatic variant more common in younger active males

›Rheumatoid variant more common in middle-aged females

›Functional impact

›Occupational disability

›PIP flexion initiation difficulty prevents grip tasks

›Musicians and manual workers suffer greatest functional loss

›Recovery timeline

›PIP injuries: up to 12-18 months for complete functional recovery

›Even with treatment, residual stiffness common

Pathophysiology

›Extensor mechanism anatomy

›Normal extensor mechanism balance

›Terminal extensor tendon inserts on dorsal distal phalanx base

›Central slip inserts on dorsal middle phalanx base

›Lateral bands run dorsolateral to PIP and insert with terminal extensor on DIP

›Oblique retinacular ligament

›Connects volar proximal phalanx to dorsal distal phalanx

›When PIP hyperextended, oblique retinacular ligament tightens and causes DIP flexion

›Key mechanical link between PIP and DIP positions

›Traumatic causation pathways

›DIP joint mechanism (most common traumatic cause)

›Terminal extensor tendon rupture (mallet finger)

›Loss of DIP extension force

›Extensor force redirected proximally to PIP via lateral bands

›PIP hyperextension develops as lateral bands migrate dorsally

›DIP remains in flexion completing the deformity

›PIP joint mechanism

›Volar plate rupture or attenuation

›Forced PIP hyperextension disrupts volar plate

›PIP joint hyperextends without restraint

›Oblique retinacular ligament tightens with PIP hyperextension

›DIP pulled into flexion completing the deformity

›Intrinsic muscle imbalance mechanism

›Lumbrical or interosseous muscle tightness

›Less common in pure acute trauma

›More common after crush injuries or intrinsic scarring

›Positive Bunnell test confirms this pathway

›Deformity progression

›Mobile to fixed deformity continuum

›Initially passively correctable (Nalebuff Type I)

›Oblique retinacular ligament shortening with time

›Volar plate and collateral ligaments contract

›Articular cartilage damage develops in late-stage (Nalebuff Type IV)

Therapeutic Considerations

›Conservative versus surgical decision framework

›Mobile deformity (Nalebuff Types I-II)

›Conservative splinting has high success rate

›Compliance with continuous splinting is primary determinant of outcome

›Premature splint removal is the most common cause of treatment failure

›Fixed deformity (Nalebuff Types III-IV)

›Surgical intervention required for meaningful improvement

›Timing: after 8-12 weeks of failed conservative management

›Nalebuff Type IV requires articular reconstruction or fusion

›Surgical outcome evidence

›Lateral band translocation

›41-digit series with 8-year mean follow-up (Charruau et al., OTSR 2016)

›Durable correction maintained in majority of cases

›Active PIP flexion improved with maintained extension correction

›FDS tenodesis

›Reliable prevention of PIP hyperextension

›Wei and Terrono series (J Hand Surg 2015) supports long-term effectiveness

›PIP motion arc preserved in most patients

›Rehabilitation principles

›Hand therapy is essential for optimal outcomes

›Edema management reduces tendon gliding resistance

›Progressive active range of motion prevents adhesion formation

›Strengthening begins after splinting phase completed

›Return to sport or work

›Protective buddy taping for return to contact sport

›Oval-8 ring splint may be worn during play for mobile deformities

›Light duty work at 4-6 weeks; heavy manual work at 12-16 weeks

›Evidence base limitations

›Most evidence from case series and retrospective cohort studies

›Level IV evidence predominates for surgical techniques

›No high-quality RCTs comparing splinting protocols or surgical methods

›Cochrane review (Chalmer et al. 2013)

›Conservative interventions for PIP hyperextension injuries

›Insufficient high-quality evidence to determine optimal splinting protocol

›Further RCTs needed

11Patient Discharge Instructions/pdi54

copy discharge instructions

›Diagnosis explanation

›Your finger has a swan neck deformity from your injury

›The middle joint (PIP) bends backward too far

›The end joint (DIP) droops downward

›This is caused by damage to the tendons or ligaments supporting the joints

›Splint instructions

›Mallet finger splint (if applicable)

›Keep the end joint (DIP) straight in the splint at ALL times

›Do not remove the splint to flex the finger — even once resets healing to zero

›You may remove the splint only to clean the skin underneath

›When cleaning, keep the DIP joint straight by pressing it against a flat surface

›Splint duration: 6-8 weeks continuous wear minimum

›PIP blocking splint (if applicable)

›Wear the oval ring or figure-of-eight splint at all times

›You may remove briefly for skin cleaning

›Replace immediately after cleaning

›Splint duration: 6-8 weeks, then night splinting for additional 4-6 weeks

›Buddy taping (if applicable)

›Tape the injured finger to the adjacent finger

›Change tape daily or if wet

›Keep tape snug but not tight enough to cause numbness

›Activity restrictions

›Avoid gripping or pinching during healing

›No lifting of objects with the injured hand for 4-6 weeks

›No contact sports until cleared by your follow-up provider

›Avoid activities that could bend the injured joint

›Wound care (if open injury)

12References/r40

Guidelines and key sources

›McKeon KE, Lee DH

›Posttraumatic Boutonniere and Swan Neck Deformities

›Journal of the American Academy of Orthopaedic Surgeons, 2015

›Primary review article grounding mechanism and classification

›Elzinga K, Chung KC

›Managing Swan Neck and Boutonniere Deformities

›Clinics in Plastic Surgery, 2019

›Comprehensive management review including surgical options

›Childress MA, Olivas J, Crutchfield A

›Common Finger Fractures and Dislocations

›American Family Physician, 2022

›Reduction techniques, splinting protocols, referral thresholds

›Dinh V, Market M, Cheung K

›Approach to Mallet Finger Injury: Practical Guide for Canadian Primary Care Physicians

›Canadian Family Physician, 2026

›Mallet finger splinting protocol and secondary swan neck prevention

›Chalmer J, Blakeway M, Adams Z, Milan SJ

›Conservative Interventions for Treating Hyperextension Injuries of the Proximal Interphalangeal Joints of the Fingers

›Cochrane Database of Systematic Reviews, 2013

›Systematic review; Level I evidence for conservative management

Surgical outcome references

›Charruau B, Laulan J, Saint-Cast Y

›Lateral Band Translocation for Swan-Neck Deformity: Outcomes of 41 Digits After a Mean Follow-Up of Eight Years

›Orthopaedics and Traumatology: Surgery and Research, 2016

›Level IV evidence; durable surgical correction data

›Wei DH, Terrono AL

›Superficialis Sling (Flexor Digitorum Superficialis Tenodesis) for Swan Neck Reconstruction

Evidence & Review