Orthopedics - Mallet Finger
Orthopedics & Podiatry Main Menu
- Traumatic flexion
deformity of the distal joint of any digit.
- This injury may be opened
- 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
- 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
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
Criteria for Return to Primary Care
Successful surgical treatment of either an
acute or chronic mallet finger with completion of necessary post-operative