This document summarizes an orthopedic extern case conference discussing a 54-year-old Thai female patient who presented to the hospital two hours after a motorcycle fell on her left ring finger. On examination, she had a 3 cm laceration wound deep to the bone on her left ring finger, with bleeding and pain on movement but no numbness. The diagnosis was an open mallet finger injury, classified as a Type II injury involving an open laceration. Treatment for this type of injury involves continuous splinting for 8 weeks with the finger in slight hyperextension.

1. Orthopedics
Extern Case Conference
Natthawut Nititanabhaworn

2. Patient profile
หญิงไทย อายุ 54 ปี
Chief complaint
รถจักรยานยนต์ล้มทับนิ้วมือซ้าย 2 ชั่วโมง
ก่อนมาโรงพยาบาล

3. Primary survey
A : can talk, no c-spine tenderness
B : no dyspnea, RR 20
C : no active external bleeding
full pulse, BP 102/80
D : E4V5M6
E : laceration wound 3 cm
at Lt. ring finger, deep to bone

4. Secondary survey
A : no drug/food allergy
M : no medication
P : no underlying disease
L : last meal 4 hr
E : รถจักรยานยนต์ที่จอดอยู่
ล้มทับนิ้วก้อยมือซ้าย มีแผลเปิด
ปวดมาก ขยับนิ้วก้อยได้ ไม่ชาปลายนิ้ว
มีเลือดออกซึมๆ เหตุเกิด 2 hr

12. Diagnosis

13. Diagnosis
Open Mallet finger

14. “Extensor tendon injury”

18. “Mallet finger”

19. “Mallet finger”

20. Doyle's Classification of Mallet Finger Injuries
Type I • Closed injury with or without small
dorsal avulusion fracture
Type II • Open injury (laceration)
Type III • Open injury (deep abrasion involving
skin and tendon substance)
Type IV • Mallet fracture
A = distal phalanx physeal injury
(pediatrics)
B = fracture fragment involving 20% to
50% of articular surface (adult)
C = fracture fragment >50% of articular
surface (adult)

21. Doyle's Classification of Mallet Finger Injuries
Type I • Closed injury with or without small
dorsal avulusion fracture
Type II • Open injury (laceration)
Type III • Open injury (deep abrasion involving
skin and tendon substance)
Type IV • Mallet fracture
A = distal phalanx physeal injury
(pediatrics)
B = fracture fragment involving 20% to
50% of articular surface (adult)
C = fracture fragment >50% of articular
surface (adult)
Continuous splinting 8 wk
Slightly hyperextension
Tendon repair
& K-wire fixation

22. Doyle's Classification of Mallet Finger Injuries
Type I • Closed injury with or without small
dorsal avulusion fracture
Type II • Open injury (laceration)
Type III • Open injury (deep abrasion involving
skin and tendon substance)
Type IV • Mallet fracture
A = distal phalanx physeal injury
(pediatrics)
B = fracture fragment involving 20% to
50% of articular surface (adult)
C = fracture fragment >50% of articular
surface (adult)
Continuous splinting 8 wk
Slightly hyperextension
Tendon repair
& K-wire fixation
Skin marceration/necrosis

24. “Swan neck deformities”

25. “Boutonniere deformities”

26. “Sagittal band rupture”

27. Thank you