From the Guidelines
Mallet finger should be managed with 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 has been shown to be effective in promoting healing and restoring the extensor mechanism 1. The management of mallet finger involves a combination of splinting, surgical intervention, and rehabilitation.
- The primary goal of treatment is to maintain the DIP joint in extension, allowing the tendon ends to approximate and heal.
- Commercial stack splints, custom thermoplastic splints, or aluminum foam splints can be used to achieve this goal.
- During splint changes, the DIP joint must remain extended to prevent disruption of healing.
- For open injuries or fractures involving more than one-third of the articular surface with palmar displacement of the distal phalanx or an interfragmentary gap of >3 mm, surgical intervention may be necessary, as indicated by the study 1.
- Surgery typically involves Kirschner wire fixation or internal fixation with screws.
- Patients should be instructed to perform gentle range of motion exercises for uninvolved joints while splinted to prevent stiffness.
- Delayed treatment can still be effective if initiated within 4-6 weeks of injury, though complete correction may not be achieved with longer delays.
- It is essential to note that radiographs are used to detect fracture fragments, as large fragments may require open reduction and internal fixation, and involvement of more than one-third of the articular surface usually requires operative fixation 1.
From the Research
Management of Mallet Finger
The management of mallet finger, an injury to the extensor tendon of the distal phalanx, can be divided into conservative and surgical approaches.
- Conservative management is typically the first line of treatment, involving immobilization of the distal interphalangeal joint in extension using a splint 2, 3.
- The type of splint and duration of use may vary, with studies showing comparable results with different splints 3, 4.
- Surgical fixation is usually reserved for specific conditions, such as:
- For bony mallet finger deformities, a modified extension-block K-wire fixation technique can be used, which involves the use of two extension-block Kirschner wires and a transarticular K-wire for precise alignment and immobilization of the distal interphalangeal joint 5.
- In cases of chronic mallet finger, surgical techniques such as Fowler's central slip tenotomy and distal interphalangeal joint arthrodesis may be considered, depending on the severity of the deformity 6.
Immobilization Methods
Different immobilization methods have been compared in the treatment of tendinous mallet finger injury, including:
- Stack orthosis
- Thermoplastic orthosis
- Aluminum orthosis
- Kirschner wire (K-wire) immobilization 4
- No significant difference was found between these methods in terms of extensor lag and total active motion, but stack orthosis was found to have superior grip strength compared to K-wire immobilization and aluminum orthosis 4.
Surgical Indications
Surgical indications for mallet finger include:
- Fracture involving greater than 30% of the articular surface
- Volar subluxation of the distal phalanx
- Avulsed fragments that fail reduction
- Injuries failing conservative management
- Absence of full passive extension of the joint 2
- Chronic mallet finger with severe deformity, where surgical techniques such as Fowler's central slip tenotomy and distal interphalangeal joint arthrodesis may be considered 6.