Multiple Bony Mallet Finger Injuries in One Hand of a 14-Year-Old Boy.

Bony mallet finger injuries, commonly seen as isolated incidents, typically occur in active individuals. We report a rare case of simultaneous avulsion fractures at the distal phalangeal bases of the second, third, and fourth fingers on the right hand of a 14-year-old boy following a forced passive flexion injury during a football game. The patient initially received conservative management with a finger extension splint for the distal interphalangeal (DIP) joints. However, one week after the injury, we performed surgical fixation on all affected digits using the K-wire extension block method due to multiple fractures and the patient's intolerance for the mallet finger splint. After six weeks, all K-wires were removed, and physiotherapy sessions began. Three months post-injury, the second and fourth DIP joints demonstrated an "Excellent" outcome, and the third DIP joint demonstrated a "Good" outcome based on Crawford's criteria for outcome assessment of mallet finger injury after management. This case highlights the importance of early detection and appropriate management of concomitant mallet finger injuries in pediatric patients to prevent potential complications that could impair hand function and quality of life.

Primary healthcare physicians' adherence to acute lower back pain referral guidelines in Riyadh, Saudi Arabia.

OBJECTIVES: To assess the primary healthcare physicians' adherence to referral guidelines for acute low back pain and if there is any association with experience level.  Methods: A cross-sectional study held in Tertiary care hospital, Riyadh, Kingdom of Saudi Arabia.Questionnaires were distributed in-person between October 2017 and January 2018 among 100 primary healthcare physicians, with a 79% response rate. Results: The distribution between male to female was 43%-57%. Twenty-five percent of physicians encounter 1-5 patients weekly, while 28% encounter more than 15 patients. The physicians included had a higher than expected adherence to referral guidelines with percentages ranging between 63-94% referral rates for back pain related red flags. A trend was noted where there was an increase in referral decisions with increased experience when encountering red flags. More experienced physicians were more likely to refer when encountering; pain worse after prolonged sitting, limited mobility, and pain worse while coughing or sneezing (p less than 0.05). Conclusion: Primary healthcare physicians working in one health system in Riyadh had a higher than expected adherence to referral guidelines for back pain related red flags.