An unlucky “double blow” to the fingers

A man in his 40s sustained a direct blow to his left middle and ring fingers with a football. He had no history of injury to these fingers or medical conditions. He immediately experienced pain and swelling in the distal interphalangeal (DIP) joints of these fingers. In the emergency department, the left middle and ring finger DIP joints were swollen, tender, and erythematous. At rest, his DIP joints were in a flexed position with full passive extension but limited active extension. No other functional deficits or neurovascular compromise were detected. An x ray was requested (fig 1)