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OrthoVellum

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Not affiliated with the Royal Australasian College of Surgeons.

Hand & Upper Limb
intermediate
X-Type

Central Slip Injuries - Boutonniere Deformity, Elson Test and Zone III Management

Extensor Tendon Injuries

A 35-year-old carpenter presents 2 weeks after jamming his ring finger in a door. He reports pain and swelling over the dorsum of the proximal interphalangeal (PIP) joint. Examination reveals weak extension at the PIP joint with the finger held in slight flexion. The distal interphalangeal (DIP) joint appears hypermobile in extension. With the PIP joint flexed 90 degrees over a table edge, attempting extension results in abnormally floppy DIP movement. The surgeon suspects a central slip injury and discusses the importance of early recognition to prevent boutonniere deformity. Regarding central slip injuries and their management:

Mark each as TRUE or FALSE

A

Central slip injury (Zone III) disrupts the main PIP extensor insertion; if untreated, the lateral b...

B

The ELSON TEST is diagnostic: with PIP flexed 90 degrees over table edge, patient attempts extension...

C

Boutonniere deformity is PIP hyperextension with DIP flexion; lateral bands migrate DORSALLY in cent...

D

Treatment of acute closed central slip injuries is PIP EXTENSION SPLINTING for 6-8 weeks; the DIP is...

E

The VOLAR mnemonic describes the mechanism: Volar migration of lateral bands, Open buttonhole for he...

Answer the questions to see explanations

Click T (True) or F (False) for each option