Best Practice Case Studies-Case 128 Asset 3 Evidence-Based Approach to Mallet Finger

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This review article provides an evidence-based, practical approach to mallet finger, a common injury of the terminal extensor mechanism causing loss of active distal interphalangeal joint (DIPJ) extension. Mallet finger may be tendinous or bony, depending on whether there is an avulsion fracture of the distal phalanx. The article traces the history of treatment and emphasizes that splinting remains the mainstay for most acute closed injuries, while surgery is reserved for selected cases.<br /><br />The authors summarize epidemiology, anatomy, and injury mechanisms. Mallet finger is more common in young men, usually affects the ulnar three digits, and often involves the dominant hand. Injury typically results from sudden flexion of an extended fingertip, though hyperextension and open injuries can also cause it. Untreated cases may lead to swan-neck deformity, and bony injuries can develop palmar subluxation of the DIPJ.<br /><br />Clinical assessment should include history, examination of extension lag, swelling, tenderness, and evaluation for deformity or contracture. Radiographs are essential for bony injuries, with lateral views used to assess fragment size and subluxation; stress views can help judge reducibility and suitability for pinning.<br /><br />For treatment, splinting is recommended for most closed tendinous mallets and stable bony mallets. Various splints exist, but no design is clearly superior. Full-time splinting for about 6 weeks, followed by night splinting, is typical. Complications are usually minor, and small residual extension lag is often functionally acceptable.<br /><br />Surgery may be considered for open injuries, irreducible displaced fractures, palmar subluxation, or patients unable to tolerate splints. Techniques include K-wire pinning, extension block pinning, hook plate fixation, and delta wiring. However, studies generally show only small differences in motion or extension lag compared with splinting, with added surgical risks.<br /><br />The authors’ preference is conservative treatment for most acute closed tendinous mallets and splinting for reducible bony mallets, reserving surgery for irreducible or unstable injuries.

Meta Tag

Edition 4th Edition

Related Case 4th Edition, Case 128

Topic Hand

Keywords

4th Edition

4th Edition, Case 128

mallet finger

terminal extensor mechanism

distal interphalangeal joint

splinting

bony mallet

tendinous mallet

avulsion fracture

surgical treatment

extension lag

DIPJ subluxation

Hand