ACCESS TO CARE External Link, Opens in New Window

making appointments

maps + parking

requesting medical records

remote access request by providers

about PRMC/TAMC

disaster preparedness (ready army)

meddac-japan

meddac-korea

u.s. army health clinic-schofield barracks

warrior ohana medical home

warrior transition battalion

leaders and organization

newcomers

reserve affairs

troop command

training and education

gme and clerkships

departments

employment

referral guidelines

contact us


Paygov

iSalute

The Safe Place

Performance Triad 26 Week Health Challenge

Tripler Guide 2013
Tripler Guide 2013

CLICK HERE for Pharmacy Information and Online Refills

Orthopedics - Mallet Finger

Orthopedics & Podiatry Main Menu

Mallet Finger

Diagnosis/Definition

  • Traumatic flexion deformity of the distal joint of any digit.
  • This injury may be opened or closed.
  • Typical history is a blow to the end of an outstretched finger or a laceration dorsally over the distal joint of the digit.

Initial Diagnosis and Management

  • Examination: There is typically a loss of full active extension with retained full passive extension.
  • AP and Lateral radiographs of the digit should be obtained and may reveal a bony avulsion fragment of variable size.  The reason for radiographic assessment, however, is to assure that the distal interphalangeal joint (DIPJ) is not subluxated or dislocated.
  • Initial management is full extension (or slight hyperextension) of the DIPJ continuously for 6 to 8 weeks.  This treatment is done for both bony and soft tissue mallet deformities and may be accomplished by a Stack splint (prefabricated splint) or by a dorsal or volar splint (made of foam-backed aluminum) that extends the DIPJ without limiting the proximal interphalangeal joint (PIPJ).
  • To prevent skin problems, any type of splint must be removed several times a day (at least 3 to 4 times per day) to check the skin to ensure it is not macerated or developing breakdown on the dorsal surface.  This condition is more commonly a problem with plastic stack splints. Maintain the DIPJ in full extension while removing splint.

Ongoing Management and Objectives

After the DIPJ has been maintained in continuous extension for 6 to 8 weeks, the splint may be removed and active, and later, active assisted flexion exercises may be initiated.  For the first 2 weeks following discontinuance of the continuous splint, an extension splint for the DIPJ should be worn during sleep.  A mild extension lag and/or a mild to moderate dorsal bump are acceptable outcomes.

Indications for Specialty Care Referral

  • An open mallet finger requiring wound care.
  • A cosmetically or functionally unacceptable result after adequate splinting.
  • Chronic mallet finger deformity (greater than 3 months from injury without any initial treatment) that is either painful, deformed, or functionally limiting.  An initial presentation with some degree of DIPJ joint subluxation.
  • Occupational requirements that necessitate the hands getting wet or that will not allow wearing of a splint.

Criteria for Return to Primary Care

Successful surgical treatment of either an acute or chronic mallet finger with completion of necessary post-operative follow-up.

Back to Top