The Diagnosis and Management of Mallet Finger Injuries

Abstract

Background: Mallet finger is a common injury of the extensor tendon insertion causing an extension lag of the distal interphalangeal joint.

Methods: We reviewed the most current literature on the epidemiology, diagnosis, and management of mallet finger injuries focusing on the indications and outcomes of surgical intervention.

Results: Nonoperative management has been advocated for almost all mallet finger injuries; however, complex injuries are usually treated surgically. There is still controversy regarding the absolute indications for surgical intervention.

Conclusions: Although surgery is generally indicated in the case of mallet fractures involving more than one-third of the articular surface as well as in all patients who develop volar subluxation of the distal phalanx, a significant advantage of surgical management even in those complicated cases has yet to be clearly proven.

Keywords: bony mallet; distal interphalangeal joint; distal phalanx fracture; extensor tendon; mallet finger.

Figure 1.

Management of closed bony mallet finger injury. Note. A 13-year-old male was referred to clinic 1 week after sustaining a hyperflexion injury in his right long finger while playing football. On examination, he was noted to have tenderness and swelling over the dorsal aspect of the distal phalanx, a flexion deformity, as well as complete loss of active extension of the distal interphalangeal joint (a). On imaging, he was found to have a bony mallet injury of the right long finger with 50% joint surface in the dorsal fragment, without volar subluxation of the distal fragment (b). Based on the extent of the injury involving more than 30% of the articular surface and following discussion with the family, we decided to proceed with closed reduction and percutaneous pinning of the fracture. At the time of the operation, an extension block wire was initially placed, entering at the dorsal middle phalanx just behind the fracture fragment, keeping the fragment and extensor tendon into position. The distal phalanx was extended to reduce the dorsal fragment (c). A K-wire was then placed through the distal phalanx, crossing the interphalangeal joint to secure the reduction. The tip of the wire was buried underneath the skin of the distal phalanx (d). The postoperative course was uneventful, and the patient regained excellent function after removal of the percutaneous wires after 6 weeks of immobilization of the joint.