From the Guidelines
Mallet finger is primarily treated with continuous splinting of the affected finger for 6-8 weeks, with the distal joint (DIP) kept in a straight position, as this approach allows the torn tendon ends to heal in close proximity while maintaining proper alignment of the finger. The treatment for mallet finger involves immobilizing the distal interphalangeal (DIP) joint in extension, using a splint that keeps the DIP joint straight while allowing the proximal interphalangeal (PIP) joint to move freely 1. Key considerations for the treatment include:
- The splint should be worn continuously for 6-8 weeks, and then at night for an additional 2-4 weeks to ensure proper healing and prevent deformity.
- For cases with significant bone fragments or joint misalignment, surgical intervention may be necessary, as indicated by involvement of more than one-third of the articular surface, palmar displacement of the distal phalanx, or an interfragmentary gap of >3 mm 1.
- Pain management can be achieved with over-the-counter medications such as acetaminophen or NSAIDs like ibuprofen.
- Ice application can help reduce swelling during the initial stages of treatment. The goal of treatment is to restore function and prevent long-term deformity, emphasizing the importance of prompt and appropriate management of mallet finger injuries.
From the Research
Treatment for Mallet Finger
- Mallet finger is a common injury involving either an extensor tendon rupture at its insertion or an avulsion fracture involving the insertion of the terminal extensor tendon 2.
- The treatment for mallet finger typically involves immobilization of the distal interphalangeal joint in extension by splints 2, 3, 4, 5, 6.
- There is no consensus on the type of splint and the duration of use, but most studies have shown comparable results with different splints 2, 4.
- Recommended immobilization duration is between 6 to 8 weeks, with additional weeks of immobilization in cases of persistent lags 3.
- Surgical fixation is still indicated in certain conditions, such as open injuries, avulsion fracture involving at least one third of the articular surface with or without palmar subluxation of the distal phalanx, and failed splinting treatment 2.
Immobilization Methods
- Different immobilization methods, such as stack orthosis, thermoplastic orthosis, aluminum orthosis, and Kirschner wire (K-wire) immobilization, have been compared in the treatment of tendinous mallet finger injury 4.
- No significant difference was found between four immobilization methods in extensor lag and total active motion (TAM) at the 8th and 12th weeks 4.
- However, the stack orthosis group was found to have significantly better results than the K-wire and aluminum orthosis groups in terms of grip strength at 12 weeks 4.
Conservative Management
- Maintaining the distal interphalangeal joint (DIPJ) in extension during treatment is essential, and patient adherence to treatment is crucial 5.
- The use of a night orthosis after the initial immobilization phase has been recommended, with some studies suggesting that it can achieve satisfying results 3, 6.
- A treatment protocol involving full-time Stack splint immobilization for 12 weeks and night orthosis wear for 4 weeks has been shown to be effective in achieving clinical and functional outcomes in patients with tendinous mallet finger 6.