From the Guidelines
Mallet finger treatment should prioritize continuous splinting of the affected finger in a straight position for 6-8 weeks, with surgery reserved for cases with large bone fragments or failed splinting, as recommended by the most recent and highest quality study 1.
Key Considerations
- The treatment goal is to prevent permanent deformity and functional limitations, particularly with fine motor tasks.
- Continuous splinting is crucial to prevent the fingertip from bending during the entire treatment period.
- A pre-made stack splint from a pharmacy or custom thermoplastic splints may be used, depending on the patient's needs.
- Night splinting for an additional 2-4 weeks is recommended after the initial splinting period.
Diagnostic Approach
- Radiographs are used to detect fracture fragments and assess for bone involvement, as noted in 1.
- Involvement of more than one-third of the articular surface or palmar displacement of the distal phalanx may require operative fixation, as indicated in 1.
Treatment Outcomes
- Most patients achieve good outcomes with proper splinting, although some residual drooping may persist, as seen in general tendon injury treatment 1.
- Relative rest, icing, and eccentric strengthening exercises may be beneficial for tendon healing, as suggested in 1 and 1.
- Surgery is an effective treatment option for carefully selected patients with persistent pain despite conservative treatment, as noted in 1.
From the Research
Definition and Treatment of Mallet Finger
- Mallet finger, also known as drop or baseball finger, is an injury where the end of a finger cannot be actively straightened out due to damage to the extensor tendon mechanism 2.
- Treatment commonly involves splintage of the finger for six or more weeks, with less frequent use of surgical fixation to correct the deformity 2.
Immobilization Methods
- Various immobilization methods have been compared in the treatment of tendinous mallet finger injury, including stack orthosis, thermoplastic orthosis, aluminum orthosis, and Kirschner wire (K-wire) immobilization 3.
- No significant difference was found between these immobilization methods in terms of extensor lag and total active motion (TAM) at 8 and 12 weeks 3.
- However, the stack orthosis group was found to have significantly better grip strength results than the K-wire and aluminum orthosis groups at 12 weeks 3.
Conservative Management
- Maintaining the distal interphalangeal joint (DIPJ) in extension during treatment is essential, emphasizing the importance of patient adherence to treatment 4.
- The use of a night orthosis after initial immobilization may be beneficial, with one study recommending immobilization for 6 to 8 weeks and additional weeks for persistent lags 5.
- A treatment protocol involving full-time Stack splint immobilization for 12 weeks and night orthosis wear for 4 weeks has been shown to achieve satisfying results in patients with tendinous mallet finger 6.
Outcomes and Evaluation
- Clinical and functional outcomes of tendinous mallet finger treatment can be evaluated using measures such as extension lag, flexion angle, and the Crawford classification scale 6.
- Patient outcomes can also be assessed using the Abouna and Brown criteria, with success rates ranging from 78% to 90% in some studies 6.