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Outlines current management of upper limb conditions in primary care settings

This information is for primary care physicians and a general summary of current practice 

Please consult a physician directly for management of specific injuries  

Zone 1 Extensor Tendon Injuries (Mallet Injuries)

Mechanism of Injury:  Crush type of injury, hyper-flexion of the DIPJ

Associated injuries: Distal Phalanx Fractures, Nail Bed Injury, Wound

Categorised: Tendinous (Extensor Tendon) + Bony Avulsion Injury

Bony Avulsion Mallet Injuries 


Surgical Mangement:

  • Bony fragment affects more than 30% of the DIPJ

  • Volar subluxation of the DIPJ or subluxation of the bony fragment (see xray) 

  • Compound fracture or associated nail ned injury

  • Review with ULQ specialist immediately

Conservative Mangement:​

  • Lag at DIPJ, closed fracture + good DIPJ alignment

  • Fracture fragment and/or DIPJ is not displaced/subluxed

  • Fracture involves less than 30% of DIPJ

  • Splint:

    • immobilise DIPJ in neutral to slight extension.

    • Include PIPJ if swan-neck

  • Review with ULQ specialist or hand therapist within a week.


DP Subluxation


Tendinous Mallet Injuries 

Unable to diagnose using x-ray as extensor tendon has ruptured. Look for extension lag at DIPJ 

Surgical Mangement:

  • Lag at DIPJ + compound injury or associated nail bed injury

  • Closed injury + has trialled conservative managment

  • Review with ULQ specialist immediately

Conservative Mangement:

  • Lag at DIPJ, but no associated bony injury

  • Closed Injury

  • Splint:

    • immobilise DIPJ in extension

    •  Include PIPJ if swan-neck present.

  • Review with ULQ specialist or hand therapist within a week


Splint DIP joint into extension with PIP joint free

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