How to Splint Mallet Finger
Splint the distal interphalangeal (DIP) joint in full extension continuously for 6-8 weeks, ensuring the finger never flexes during this period, as even brief removal restarts the healing timeline.
Splinting Technique and Position
Position the DIP joint in full extension (0 degrees) or slight hyperextension while leaving the proximal interphalangeal (PIP) joint completely free to move 1, 2.
Apply a rigid splint (such as a Stack splint or similar dorsal/volar splint) that immobilizes only the DIP joint 1, 3.
Verify that the PIP joint moves freely within the splint after each application to prevent stiffness 4.
Support the finger volarly (from underneath) when applying or adjusting the splint to prevent any DIP joint flexion 4.
Duration and Compliance Requirements
Maintain continuous splinting for 6-8 weeks without interruption, as this is critical for tendon healing 3, 5, 2.
Continue night splinting for an additional 2 weeks after the initial 6-8 week period 3, 4.
Never allow the DIP joint to flex during the entire treatment period, as even brief flexion episodes restart the healing timeline and can lead to treatment failure 1.
Skin Care Protocol
Remove the splint once daily for 10 minutes maximum to clean the finger and inspect for skin breakdown 4.
Maintain DIP joint extension manually during cleaning by supporting the finger volarly throughout the entire cleaning process 4.
Apply ice-water mixture for 10-20 minutes with a thin towel barrier initially to reduce swelling, but avoid heat application 1.
Critical Pitfalls to Avoid
Do not attempt to straighten the finger forcefully before splinting; splint in the position found and refer for proper evaluation 1.
Avoid removable splints or allowing patient discretion in splint removal, as compliance rates are poor (approximately 65%) even with comprehensive instructions 4.
Do not use splinting for fracture-dislocations with subluxated palmar fragments, as these require surgical intervention 5, 2.
Recognize that chronic mallet fingers (4-18 weeks old) can still be treated successfully with the same 8-week continuous splinting protocol, though recurrence rates are higher 3.
Expected Outcomes
Anticipate an extensor lag of approximately 12 degrees even with full compliance to the splinting protocol 4.
Recurrence can occur within one week after splint removal in approximately 20% of cases, requiring an additional 8 weeks of splinting 3.
Patient satisfaction rates are approximately 53% even with perfect compliance, reflecting realistic expectations for this injury 4.