In distal extensor tendon injuries with an associated avulsion fracture, referral to orthopedics is advised when the avulsion involves more than what percentage of the joint space?

In distal extensor tendon injuries with an associated avulsion fracture, referral to orthopedics is advised when the avulsion involves more than what percentage of the joint space?

• A. More than 60% of the joint space
• B. More than 50% of the joint space
• C. More than 30% of the joint space
• D. Any avulsion fracture requires immediate referral

Answer: (C)

When a distal extensor tendon injury comes with a bone fragment (an avulsion), how much of the joint surface is involved helps decide treatment. If the avulsed fragment covers about one-third (roughly 30%) of the joint surface or less, nonoperative care with splinting in extension can often allow the tendon to heal and preserve joint alignment. But once the fragment exceeds about 30% of the articular surface, the joint surface can become unstable or incongruent, increasing the risk of persistent extensor lag or malalignment. In that scenario, referral to orthopedics for potential surgical fixation is advised. Smaller fragments without instability can be managed conservatively, while larger or unstable injuries require specialist input.

When a distal extensor tendon injury comes with a bone fragment (an avulsion), how much of the joint surface is involved helps decide treatment. If the avulsed fragment covers about one-third (roughly 30%) of the joint surface or less, nonoperative care with splinting in extension can often allow the tendon to heal and preserve joint alignment. But once the fragment exceeds about 30% of the articular surface, the joint surface can become unstable or incongruent, increasing the risk of persistent extensor lag or malalignment. In that scenario, referral to orthopedics for potential surgical fixation is advised. Smaller fragments without instability can be managed conservatively, while larger or unstable injuries require specialist input.