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Extension Block Casting


- See: Phalangeal Injury

- Discussion:
    - takes advantage of stabilizing forces of flexor & intrinsic on phalanges with the MP joint held in 90 deg flexion;
    - intact dorsal extensor mechanism functions as  "tension band" to palmar cortex, and helps maintain the reduction;
    - digital rotation and angulation are largerly controlled by having four digits move together;

- Indications:
    - Proximal Phalanx Frx;
            - closed dorsally angulated transverse frx;
            - short oblique shaft frx;
            - impacted base proximal phalangeal fractures;
    - PIP dorsal dislocations

- Technique:
    - anesthesia: metacarpal or wrist block;
    - fracture is reduced w/ longitudinal traction w/ MP in maximal flexion;
    - buddy tapping the digits maintains rotational control and improves stability;
    - splint:
            - wrist in 30 deg of extension;
            - MP joints in 90 deg of flexion,
            - on dorsal side cast is extended to PIP joint;
            - leave PIP joint free;
            - phalanges should have full range of flexion;
    - begin active digital motion

Extension Block Pinning for Unstable Proximal Interphalangeal Joint Dorsal Fracture Dislocations

Dorsal fracture subluxation of the distal interphalangeal joint of the finger and the interphalangeal joint of the thumb treated by extension block splintage.

Extension block pinning for proximal interphalangeal joint fracture dislocations: preliminary report of a new technique.

A new method of extension-block splinting for the proximal interphalangeal joint--Preliminary report.