Avulsion distal phalanx - The Ultrasound Site

Ultrasound Case Study

Avulsion injury of the distal phalanx

Stuart Wildman, Extended Scope Physiotherapist and MSK Sonographer

This patient in their early 30’s, presented with a left 3rd metacarpal injury.  She recalled falling over and feeling pain and discomfort in the distal interphalangeal joint. She also noticed an inability to extend her finger fully. On examination, she presented with a mallet finger, and no activation of DIP extension.

On ultrasound in clinic, there was disruption to the distal insertion of the extensor tendon onto the distal phalanx, with an area of cortical irregularity. The sonographic appearance and clinical presentation was suggestive of an avulsion injury of the distal phalanx.

The patient was referred for an x-ray to confirm the ultrasound images, and the report indicated:

‘There is a non united avulsion fracture of the proximal segment of the distal phalanx, major finger left hand. ‘

This patient was subsequently seen in fracture clinic and then had ongoing hand clinic input.

Article of interest:
Moschilla & Breidah (2003) Sonography of the finger, American Journal of Roentgenology

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