NMS Q&A Family Medicine

146 NMS Q&A Family Medicine(D) PIP dislocation(E) Stoving injury to the end of the middle finger14 A 16-year-old male catcher on the high school baseballteam had a foul tip strike his left (non-gloved)hand and arrives with pain the next day to your office.There is tenderness and ecchymosis over the dorsalaspect of the DIP joint of the thumb. The patient canfully flex the joint, but he has lost 20 degrees ofextension, compared with the normal hyperextensionseen in the thumb. No fracture is revealed onx-rays. What is the most likely treatment of thepatient?(A) Surgical repair of injured extensor mechanism(B) Continuous splinting in extension for 6 weeks(C) Continuous splinting in 20 degrees of flexionfor 6 weeks(D) Arthrodesis (fixation of the joint) in hyperextensionof the thumb PIP joint(E) Only NSAIDs because the x-ray shows no fracture15 A patient has incurred a fracture of the middle phalanxof left ring finger that extends into the DIP joint,involving 50% of the articular surface. Which of thefollowing treatment plans is most appropriate?(A) Open reduction and internal fixation(B) Splint the finger in 25 degrees of flexion for sixweeks(C) Buddy tape the finger to the adjacent middlefinger for 6 weeks(D) Immobilization for 2 weeks followed by activerange of motion(E) Physical therapy forthwith to retain range ofmotion