Mallet finger

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Background

  • Rupture of extensor tendon in area of distal phalanx distal to DIP joint
    • May be accompanied by avulsion fracture
  • Caused by forced flexion of extended DIP joint
  • If untreated, leads to swan neck deformity
Finger in maximum extension
Mallet finger without fracture
Mallet finger with fracture at the insertion of the extensor tendon

Clinical Features

  • DIP joint flexed to 40°, unable to fully extend

Differential Diagnosis

Hand and finger injuries

Evaluation

  • Clinical diagnosis
  • Consider finger x-ray (PA and lateral) to evaluate for avulsion fracture

Management

  • Splint DIP joint in continuous slight hyperextension x 6 wk
  • Splinting of the PIP joint is not necessary and should be avoided[1]
    • Inadvertently splinting PIP for 6 weeks results in collateral ligamentous overgrowth and functional disability[2]
  • Give an extra splint
Special Mallet finger splint (if available)

Disposition

  • Discharge with hand surgery follow-up in 7-10 days

See Also

References

  1. Katzman B et al. Immobilization of the mallet finger: effects of the extensor tendon. J Hand Surg Br. 1992; 24(1):80-84
  2. Prosser R. Splinting in the management of proximal interphalangeal joint flexion contracture. J Hand Ther. 1996 Oct-Dec;9(4):378-86.