From the Guidelines
Mallet finger treatment should always prioritize continuous splinting of the affected finger in a straight position for 6-8 weeks, as this approach has been shown to yield the best outcomes in terms of morbidity, mortality, and quality of life. When managing mallet finger, it is essential to consider the extent of the injury, including any potential bone fragments or articular surface involvement, as noted in the study by 1. Key considerations for treatment include:
- Continuous splinting for 6-8 weeks to ensure proper healing of the extensor tendon
- The use of a stack splint or commercially available mallet finger splint to maintain the finger in a straight position
- Avoiding any bending of the fingertip during the initial treatment period to prevent restarting the healing process
- Night splinting for an additional 2-4 weeks after the initial treatment period
- Pain management using over-the-counter medications like acetaminophen or ibuprofen, as needed
- Surgical intervention may be necessary for severe cases with large bone fragments or persistent deformity despite proper splinting, as indicated by the criteria outlined in 1. In terms of specific treatment protocols, the study by 1 highlights the importance of radiographs in detecting fracture fragments and assessing the need for operative fixation, particularly in cases involving more than one-third of the articular surface or palmar displacement of the distal phalanx. Overall, the primary goal of treatment is to restore proper function and minimize the risk of long-term deformity, such as swan-neck deformity, which can significantly impact quality of life.
From the Research
Treatment Options for Mallet Finger
- Mallet finger is a flexion deformity of the finger resulting from injury to the extensor mechanism at the base of the distal phalanx 2
- Treatment can be difficult as patient compliance is essential, and if not treated appropriately the injury can lead to permanent deformity 2
Conservative Management
- Closed mallet finger injuries are managed in a strict extension or hyperextension immobilisation splint for 8 weeks 2
- Four different immobilization methods (stack orthosis, thermoplastic orthosis, aluminum orthosis, and Kirschner wire [K-wire] immobilization) have been compared, with no significant difference found between them in extensor lag and total active motion (TAM) at the 8th and 12th weeks 3
- Stack orthosis has been found to have significantly better results than K-wire and aluminum orthosis in terms of grip strength at 12 weeks 3
- Long-term Stack splint immobilization for 12 weeks, followed by night orthosis for 4 weeks, has been shown to achieve satisfying results in the treatment of tendinous mallet finger injuries 4
Surgical Intervention
- 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
- Internal fixation via Kirschner Wire (K-W) may be a suitable treatment option compared to splint therapy for management of closed soft-tissue mallet finger in noncompliant patients 5