From the Research
Pinning of mallet finger under general anesthesia is generally not recommended for most cases. The standard treatment for mallet finger injuries is conservative management with continuous splinting for 6-8 weeks, keeping the distal interphalangeal (DIP) joint in slight hyperextension. This approach is supported by a recent study published in 2022, which found that splinting is a safe and effective treatment method for soft tissue mallet finger injuries, with a lower complication rate compared to percutaneous pinning 1.
Key Considerations
- Surgical intervention, including pinning, is typically reserved only for specific situations such as large bony fragments (>30% of the articular surface), volar subluxation of the distal phalanx, or failed conservative treatment.
- When surgical intervention is necessary, it can usually be performed under local anesthesia with digital block using 1-2% lidocaine without epinephrine (typically 2-3 ml), rather than requiring general anesthesia.
- The risks of general anesthesia generally outweigh the benefits for this relatively minor procedure.
- Most mallet finger injuries heal well with proper splinting, and surgery carries risks of infection, nail deformity, and joint stiffness.
Treatment Outcomes
- Patients should understand that even with proper treatment, some permanent extensor lag (slight drooping of the fingertip) may remain, but this is usually minimal and doesn't affect hand function significantly.
- A study published in 2020 found that splinting and extension-block pinning of bony mallet finger injuries had similar outcomes in terms of active extension lag and patient-reported function and pain scores 2.
- Another study published in 2022 reported a rare but devastating complication of percutaneous pinning of the DIP joint for closed tendinous mallet finger, highlighting the importance of careful consideration of treatment options 3.
Evidence-Based Recommendations
- The current evidence suggests that conservative management with splinting is the preferred treatment method for most mallet finger injuries.
- Surgical intervention should be reserved for specific situations where the benefits outweigh the risks.
- General anesthesia is not typically recommended for pinning of mallet finger, and local anesthesia with digital block is a safer and more effective alternative.