From the Guidelines
The recommended management for mallet finger involves continuous splinting of the distal interphalangeal (DIP) joint in extension for 6-8 weeks, followed by 2-4 weeks of nighttime splinting, as this approach allows the torn extensor tendon to heal in the correct position, restoring the finger's ability to extend 1.
Key Considerations for Mallet Finger Management
- The primary goal of treatment is to maintain the DIP joint in extension to facilitate proper healing of the extensor tendon.
- Radiographs are sufficient for evaluating osseous "mallet" injuries and detecting fracture fragments that may require open reduction and internal fixation 1.
- Surgical intervention is typically reserved for cases with large bony fragments involving more than one-third of the articular surface, palmar displacement of the distal phalanx, or an interfragmentary gap of >3 mm 1.
- Various splint options are available, including stack splints, aluminum-foam splints, or custom thermoplastic splints, and the choice of splint should be based on patient comfort and compliance.
- Regular monitoring for skin maceration and pressure sores under the splint is crucial to prevent complications.
Special Considerations
- For patients with delayed presentation, splinting can still be effective, although complete correction may not be achieved.
- The splint should be worn at all times, even during bathing, to maintain the fingertip in a straight position and prevent disrupting the healing process.
- Patients should be educated on proper splint care and the importance of maintaining the DIP joint in extension during the treatment period.
From the Research
Mallet Finger Management
Mallet finger is a flexion deformity of the finger resulting from injury to the extensor mechanism at the base of the distal phalanx. The recommended management for mallet finger includes:
- Closed mallet finger injuries are managed in a strict extension or hyperextension immobilisation splint for 6 to 8 weeks 2, 3, 4, 5
- Surgery is reserved for injuries involving fracture to greater than 30% of the articular surface, volar subluxation of the distal phalanx, avulsed fragments that fail reduction, injuries failing conservative management, and absence of full passive extension of the joint 2, 3, 5, 6
- Nonoperative management has been advocated for almost all mallet finger injuries; however, complex injuries are usually treated surgically 6
- Immobilization duration is between 6 to 8 weeks and with additional weeks of immobilization in cases of persistent lags 4
Indications for Surgical Intervention
Surgical intervention is generally indicated in the following cases:
- Mallet fractures involving more than one-third of the articular surface 3, 5, 6
- Volar subluxation of the distal phalanx 2, 5, 6
- Avulsed fragments that fail reduction 2
- Injuries failing conservative management 2, 3, 5
- Absence of full passive extension of the joint 2
Treatment Outcomes
Treatment outcomes for mallet finger injuries have shown comparable results with different splints 3, 5. Increased edema and age and decreased patient adherence seem to negatively influence DIP extension gains 4.