A 14-year-old male high school volleyball player was seen to evaluate right- and left-hand little-finger distal interphalangeal joint deformity and pain. His symptoms began during his second season of competitive play. The distal interphalangeal (DIP) joints of the little fingers flexed 20-30°, and a 10-15° valgus deformity was seen at the same joints. Pain was relieved with rest but returned immediately after playing volleyball, so plain radiographs were obtained. The flexion and valgus deformity was obvious on plain radiographs and through a clinical examination. Thus, a bilateral little-finger distal phalanx base epiphysis injury was seen. This injury is characterized by a biplanar Salter Harris physeal injury; type 5 on anteroposterior radiographs and type 2 on lateral plain radiographs. The deformity occurred as a result of competitive volleyball play. To our knowledge, this is the first reported case of a bilateral biplanar physial injury of the base of distal phalanges of the little fingers. Flexion and valgus deformities of DIP joints are a result of repeated micro traumas around the physis. |