What is the treatment for a 33-year-old male with a mallet finger (injury to the extensor tendon) of the ring finger following a reduced dislocation at the distal interphalangeal (DIP) joint?

From the Guidelines

For a 33-year-old male with a mallet finger (injury to the extensor tendon) of the ring finger following a reduced dislocation at the distal interphalangeal (DIP) joint, the recommended treatment is continuous splinting of the DIP joint in extension for 6-8 weeks. The splint should be worn full-time, keeping the DIP joint in a neutral or slightly hyperextended position while allowing the PIP joint to move freely. Commercially available stack splints or custom-made thermoplastic splints work well. The patient must wear the splint continuously, even while bathing, to prevent any flexion of the DIP joint during the healing period. After the initial 6-8 weeks, night splinting should continue for an additional 2-4 weeks. This treatment addresses the underlying pathology - disruption of the terminal extensor tendon insertion at the distal phalanx, which causes the characteristic drooping of the fingertip. Splinting allows the tendon to heal in the proper position. If splinting fails after appropriate duration and compliance, or if there is a large bony fragment (>30% of the articular surface), surgical intervention may be necessary. Surgery typically involves pinning the DIP joint in extension or direct repair of the tendon. Early treatment yields the best outcomes, so prompt splinting is essential for this patient. Relative rest, as suggested by 1, is also important to decrease repetitive loading of the damaged tendon, but the primary treatment should focus on continuous splinting to ensure proper healing of the extensor tendon. Key points to consider in the treatment plan include:

• Continuous splinting for 6-8 weeks
• Night splinting for an additional 2-4 weeks
• Relative rest to decrease repetitive loading of the damaged tendon, as recommended by 1
• Prompt treatment to yield the best outcomes.

From the Research

Treatment Options for Mallet Finger

The treatment for a 33-year-old male with a mallet finger (injury to the extensor tendon) of the ring finger following a reduced dislocation at the distal interphalangeal (DIP) joint includes:

• Conservative management with a 6-to-8-week period of uninterrupted immobilization of the DIP joint with an external splint 2, 3
• Splinting has been shown to be highly effective and safe for both acute and chronic lesions 2, 3
• If external splinting fails in an acute injury, a second trial of conservative management can be considered, and if this fails, surgery may be offered 2, 3

Surgical Treatment

Surgical treatment may be considered in selected cases, including:

• Placement of a trans-articular Kirschner wire at the DIP joint 2, 3
• Conjoint tendon advancement 2
• Terminal extensor tendon reconstruction, which has been shown to be a reliable option for chronic mallet finger with swan neck deformity 4
• Bunnel's pull-out suture for mallet fractures 2

Rehabilitation

Finger rehabilitation is an indispensable part of any method of treatment, aiming to improve finger function, restore normal active-passive flexion of proximal (PIP) and distal interphalangeal (DIP) joint, relieve pain, and improve cosmetic appearance 4

Immobilization Methods

Different immobilization methods can be used, including:

• Stack orthosis
• Thermoplastic orthosis
• Aluminum orthosis
• Kirschner wire (K-wire) immobilization No significant difference was found between these methods in terms of extensor lag and total active motion (TAM) at the 8th and 12th weeks, but stack orthosis was found to have significantly better results in terms of grip strength compared to K-wire and aluminum orthosis 5