What is the treatment for mallet finger?

From the Guidelines

The treatment for mallet finger typically involves continuous splinting of the distal interphalangeal (DIP) joint in extension for 6-8 weeks, as this approach has been shown to be effective in managing osseous "mallet" injuries, including bony avulsion at the insertion of the extensor mechanism of the finger to the distal interphalangeal joint 1.

Key Considerations for Mallet Finger Treatment

• Continuous splinting is crucial to keep the DIP joint fully extended, allowing the tendon to heal properly without disruption.
• The splint should be worn at all times, even during bathing, to prevent any flexion of the fingertip.
• After the initial 6-8 weeks, night splinting is recommended for an additional 2-4 weeks to ensure complete healing.
• Custom or pre-fabricated splints can be used, with the key being to keep the DIP joint fully extended while allowing the middle joint (PIP) to move freely.
• Ice and elevation in the first few days can help reduce swelling, and over-the-counter pain medications like acetaminophen or ibuprofen may be used for discomfort.

Indications for Surgery

• Surgery is generally reserved for cases with large bone fragments, joint misalignment, or when splinting fails after appropriate treatment, 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.
• These conditions may require operative fixation to ensure proper healing and prevent long-term complications.

Expected Outcomes

• Most patients achieve good functional outcomes with proper splinting, though some may have a slight permanent droop of the fingertip.
• The goal of treatment is to restore function and minimize morbidity, mortality, and impact on quality of life, which can be achieved through careful management and adherence to treatment protocols.

From the Research

Mallet Finger Treatment

• Mallet finger is a deformity that results from the loss of extensor function of the distal interphalangeal joint, and its treatment can be both difficult and controversial 2.
• The management of mallet finger often involves orthopedic treatment, which is less invasive but requires greater patient participation to implement 2, 3.
• Many authors advocate for orthopedic treatment, and various orthopedic methods have been proposed, including the use of splints 2, 3, 4, 5.
• A dorsal adhesive splint has been shown to be an effective treatment for all types of mallet finger, reducing the number of indications for surgery 2.
• This splint preserves digital pulp function and improves patient observance, with a lower rate of complications compared to other techniques 2.
• The splint is typically worn for eight weeks for tendon injuries and six weeks for bony injuries, followed by nighttime wear for two weeks 2.
• Surgical treatment is usually reserved for deformities resulting from a fracture with a subluxated palmar fragment, and only when conservative treatment has failed 3, 6.
• A randomized clinical trial found no significant differences in active extension lag between nonoperative splinting and extension-block pinning of bony mallet fingers 6.
• However, splinting was found to be safe and efficient in restoring joint motion, but it did not sufficiently prevent secondary subluxation of the joint 6.
• Other types of splints, such as the Pipflex splint, have also been shown to be effective in treating mallet finger deformity 5.
• The choice of treatment ultimately depends on the type and severity of the injury, as well as patient factors and preferences 2, 3, 4, 6, 5.