From the Guidelines
Mallet finger treatment should always involve 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 evaluating patients with suspected finger tendon injuries, such as mallet finger, radiographs are used to detect fracture fragments, as large fragments may require open reduction and internal fixation 1. The goal of treatment is to allow the tendon to heal and restore normal function to the finger. Key considerations for treatment include:
- Continuous splinting of the affected finger in a straight position for 6-8 weeks, even during bathing
- The splint should be applied with the finger completely straight or slightly hyperextended
- A pre-made stack splint from a pharmacy works well for most cases, though custom thermoplastic splints may be needed for some patients
- It's crucial not to allow the fingertip to bend during the entire treatment period, as even brief flexion can restart the healing process
- After the initial splinting period, night splinting for an additional 2-4 weeks is recommended
- Surgery is generally reserved for cases with large bone fragments 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. Without proper treatment, patients may develop permanent deformity and functional limitations, particularly with fine motor tasks requiring fingertip precision.
From the Research
Treatment Options for Mallet Finger
- Mallet finger is typically treated with immobilization in a splint or cast to allow the extensor tendon to heal [(2,3,4,5,6)].
- The most common method of immobilization is a strict extension or hyperextension splint, which is usually worn for 6-8 weeks [(2,3,4,5)].
- Surgery is typically reserved for more severe cases, such as those involving a fracture or volar subluxation of the distal phalanx [(2,3)].
- Different types of splints have been compared in various studies, including custom-made thermoplastic orthoses, Quickcast orthoses, stack orthoses, aluminum orthoses, and Kirschner wire immobilization [(4,5,6)].
Comparison of Immobilization Methods
- A study comparing Quickcast and custom-fabricated thermoplastic orthoses found that Quickcast immobilization resulted in fewer skin complications and less pain 4.
- Another study comparing four different immobilization methods (stack orthosis, thermoplastic orthosis, aluminum orthosis, and Kirschner wire immobilization) found no significant difference in extensor lag or total active motion, but the stack orthosis group had significantly better grip strength at 12 weeks 5.
- A Cochrane review of interventions for treating mallet finger injuries found insufficient evidence to establish the relative effectiveness of different finger splints, but noted the importance of patient adherence to instructions for splint use 6.
Surgical Intervention
- Surgical fixation, such as Kirschner wire fixation, may be used in some cases, but the evidence for its effectiveness is limited [(3,6)].
- Surgery is typically considered for cases where conservative management has failed or in cases with more severe injuries, such as fractures or volar subluxation [(2,3)].