VCOM Research Day Program Book 2023

Medical Student Research Case Reports

22 In-Season Treatment of a Finger Fracture in a Division I Football Offensive Lineman

Bryce Bossinger; Brett Greisemer, MAEd, LAT, ATC, CSCS; Alex Black, MAEd, LAT, ATC; Miguel Silva, LAT, ATC; Peter J. Apel, MD, PhD; Matthew Chung, DO, CAQSM Corresponding author:

Edward Via College of Osteopathic Medicine-Virginia Campus Carilion Clinic, Virginia Tech

Case Description: right hand dominant patient presented with right hand pain localized to second finger after jamming the finger while making a block during football practice. Patient felt a pop at the proximal phalanx but was able to take Ibuprofen for pain and finish practice. Upon physical exam, he had obvious swelling around the second distal interphalangeal joint and around the second proximal phalanx. Shaft of second proximal phalanx was tender to palpation. Finger had very limited range of motion secondary to swelling. X-ray confirmed oblique fracture of the shaft of the proximal phalanx of the right second digit with no displacement or angulation. As the injury occurred in season, the patient and medical team elected to treat the injury conservatively. Surgical reduction was forgone for the time being in favor of buddy taping and casting during football activities so he could continue to participate. Patient was supplemented with 5000 IU vitamin D and 500 mg calcium daily to support bone healing.

Setting: Outpatient clinic Patient: 19-year-old male division 1 football offensive lineman Assessment/Results: Follow up occurred three weeks later at the conclusion of the season. Pain improved significantly, but range of motion was still poor. Terminal passive flexion of the finger caused sharp pain. Repeat X-rays show early healing but now also show the fracture is displaced with some shortening and apex volar angulation. Fracture was determined to be clinically healed based on the absence of pain at the fracture site. Cosmetic appearance of the finger may be altered in the future, but as long as the displacement doesn’t cause functional issues, the next important step is getting back range of motion. Patient was educated on exercises to achieve that goal and set for follow-up in 4 weeks

Discussion: This is an interesting case due to the patient’s status as a division 1 athlete with playing time on the line. Surgical repair after the first visit was likely the best course of treatment given that it was a long oblique fracture, which is more likely to displace than other types. The case being a right hand injury to someone that is right-handed was another complicating factor, but his wish to continue participating was granted due to the fracture being non-displaced at the time. If a player is not an established starter on the team, missing even three games can cost them any chance they may have to earn their spot in the lineup.

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