Mallet Finger: Immediate Management and Referral
You have a mallet finger injury—immediately splint the DIP joint in extension without attempting to straighten it yourself, apply ice for pain control, and seek urgent medical evaluation within 24 hours for X-ray and definitive splinting. 1
Immediate First Aid Actions
Stop all activity and avoid using the injured finger. 2 Any painful extremity injury that limits use requires immediate cessation of activities that cause pain and prompt medical attention.
Apply ice-water mixture for 10-20 minutes with a thin towel barrier to reduce swelling and pain. 1 Use a bag filled with ice and water surrounded by a damp cloth—this achieves the greatest tissue cooling. 2 Limit cold application to 20-30 minutes per session, 3-4 times daily, and never place ice directly on skin to prevent cold injury. 2
Remove any rings or constricting jewelry immediately from the injured finger, as swelling may cause them to constrict and damage the finger. 1
Do NOT attempt to straighten the finger or apply heat. 1 Avoid heat application entirely and do not try to manually correct the deformity before proper splinting.
Critical Understanding: What You Have
Mallet finger is a disruption of the extensor tendon at the DIP joint, preventing you from actively straightening the fingertip. 3, 4 This occurs from either:
- Tendon rupture at its insertion (tendinous mallet finger)
- Avulsion fracture where the tendon pulls off a bone fragment (bony mallet finger) 3
If left untreated, this progresses to swan neck deformity with PIP joint hyperextension and permanent DIP joint flexion. 4
Urgent Medical Evaluation Required
Seek medical attention within 24 hours for X-ray evaluation. 1 Standard radiographs are sufficient to differentiate between tendinous and bony mallet finger—advanced imaging like MRI or CT is not needed for routine diagnosis. 1
X-rays determine whether surgery is needed. 1 Surgical indications include:
- Avulsion fractures involving ≥1/3 of the articular surface 1, 3
- Palmar subluxation of the distal phalanx (>3mm interfragmentary gap or irreducible subluxation) 1
- Open injuries 1, 3
Definitive Treatment Expectations
Most mallet fingers (approximately 80-90%) are treated non-surgically with continuous splinting for 6-8 weeks. 3, 5 The key to success is uninterrupted immobilization—even brief removal of the splint restarts the entire healing timeline. 1
Begin active motion exercises of the PIP and MCP joints immediately while keeping the DIP splinted to prevent stiffness in the other joints. 1
After 6 weeks of continuous splinting, gradual weaning begins with an overnight splint used for an additional 4-6 weeks. 6
Critical Pitfall to Avoid
The single most common cause of treatment failure is removing the splint during the immobilization period. 1 Even momentary removal to wash or inspect the finger resets the healing clock to day zero. Patients must understand this is a 6-8 week commitment to continuous splinting.
Re-evaluate immediately if unremitting pain develops during the immobilization period, as this may indicate complications. 1