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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.
