From the Guidelines
The best treatment for mallet finger is continuous splinting of the distal joint in extension for 6-8 weeks, as this approach allows the torn tendon to heal in the correct position and minimizes the risk of complications, as indicated by the general principles of managing osseous "mallet" injuries 1. When managing mallet finger, it's essential to consider the extent of the injury, including any potential bony avulsion at the insertion of the extensor mechanism of the finger to the distal interphalangeal joint.
- Key considerations in the treatment of mallet finger include:
- The size of the bone fragment, with involvement of more than one-third of the articular surface typically requiring operative fixation 1.
- The presence of palmar displacement of the distal phalanx or an interfragmentary gap of >3 mm, which also indicates a need for surgical intervention 1.
- The importance of maintaining extension throughout the treatment period to prevent resetting the healing process.
- A stack splint or custom-made splint should be worn 24 hours a day without removing it, even during bathing, to keep the fingertip straight while allowing the middle joint to bend.
- After the initial 6-8 week period, night splinting is recommended for an additional 2-4 weeks to ensure complete healing.
- Surgery is generally reserved for cases with large bone fragments, joint misalignment, or when conservative treatment fails, as these situations may require more invasive management to achieve optimal outcomes 1.
From the Research
Treatment Options for Mallet Finger
- Mallet finger can be treated with either orthopedic methods or surgical treatment, with no consensus on the best approach 2.
- Orthopedic treatment involves immobilizing the distal interphalangeal joint in extension using a splint, with various types of splints available 3, 2, 4, 5.
- The duration of splint use varies, but most studies recommend 6-8 weeks of full-time immobilization, followed by night-time orthosis wear for several weeks 2, 4.
Comparison of Treatment Outcomes
- A systematic review and meta-analysis found no significant difference in treatment outcomes between surgical intervention and conservative treatment with orthosis splint for both bony and tendinous mallet finger 6.
- The study found that both surgical and orthosis treatments resulted in similar distal interphalangeal joint extension lag angles, flexion angles, and range of motion angles 6.
- Another study found that using a dorsal adhesive splint resulted in a lower complication rate and better outcomes compared to other orthopedic methods 3.
Specific Treatment Protocols
- One study used a Stack splint with full-time immobilization for 12 weeks, followed by night orthosis wear for 4 weeks, and found satisfactory results in 78% of patients 4.
- Another study used a Pipflex splint, which maintains extension of the DIP joint and flexion of the PIP joint, and found superior results compared to other methods of splintage 5.
- A retrospective analysis of 270 mallet finger cases found that using a dorsal adhesive splint resulted in a mean extension deficit of 2.38 degrees, which is better than reported in other series in the literature 3.