Mallet Finger Impormasyon In-depth

Ang iyong nararamdaman

Sa mallet finger, lumalaylay ang dulo ng kasukasuan (joint) ng iyong daliri at hindi mo kayang ituwid ang dulo ng daliri nang mag-isa. Ang daliri ay maaaring magmukhang baluktot sa huling kasukasuan, ang pinakamalapit sa kuko. Nangyayari ang pinsalang ito kapag ang tendon na nagtutuwid sa kasukasuaang iyon ay napunit o nahila, kung minsan ay may kasamang maliit na piraso ng buto.

Ang dulo ng kasukasuan ay madalas na maselan at maaaring mamaga o magkapasa, lalo na sa mga araw matapos itong mangyari. Ang pagtulak sa dulo ng daliri upang ituwid, paghawak sa bola, o pagkabagok ng daliri ay maaaring magpalala sa sakit. Ang pagpapanatiling hindi gumagalaw sa daliri, na sinusuportahan ng isang splint, ay karaniwang nakakapagpakalma nito.

Sa araw-araw, ang lumalaylay na dulo ay nakakasagabal sa mga detalyadong gawain. Ang pagpulot ng mga barya, pagbubutones ng maliliit na butones, pagta-type, o paghawak ng panulat ay maaaring magmukhang lampa dahil ang dulo ng daliri ay hindi maitutulak nang tuwid. Ang mga ball sports ay isang karaniwang paraan kung paano nakukuha ng mga tao ang pinsalang ito, at ang pagkaka-jam ng daliri habang naglalaro ay madalas na pinagmumulan nito.

Ang ilang mga daliri ay nagkakaroon din ng pangalawang problema sa mas itaas na bahagi ng daliri. Kapag lumalaylay ang dulo ng kasukasuan, ang gitnang kasukasuan ay maaaring magsimulang sumobra ang pagtuwid o bumaluktot pabalik. Kung mapansin mo ito, banggitin ito, dahil binabago nito kung paano ginagamot ang daliri.

May isang bagay na mas mahalaga kaysa sa halos lahat: ang timing. Ang maagang pagpatingin at paglalagay ng splint sa daliri, mainam na sa loob ng dalawang linggo matapos ang pinsala, ay nagbibigay ng pinakamahusay na pagkakataon para sa isang tuwid at gumaganang dulo ng daliri. Ang paghihintay ay maaaring humantong sa permanenteng paninigas o sa isang kasukasuan na hindi na nakalinya nang maayos. Kung ang iyong daliri ay matagal nang lumalaylay, mahalaga pa ring ipasuri ito, dahil may mga opsyon para sa mga daliring hindi naagapan ng gamutan.

Hindi mo kailangang hulaan kung gaano ito kalala. Ang lumalaylay na dulo ng daliri matapos ang isang pagkabagok ay sapat na dahilan upang ipasuri ito, upang ang tamang splint o gamutan ay masimulan bago magbago ang kasukasuan.

Ano ang aktwal na nangyayari

Natuwid ang dulo ng iyong daliri dahil may isang manipis na cord ng tendon, isang lubid ng matitibay na fiber, na tumatakbo sa likod ng daliri at nakakabit sa huling buto. Sa mallet finger, ang cord na iyon ay napuputol o nahuhugot mula sa pagkakakabit nito, at kung minsan ay may kasamang maliit na piraso ng buto. Ang dulo ng joint ay hindi na maitutulak nang tuwid mula sa likod, kaya ang tendon na nagbobaluktot sa joint ay hinihila ito pababa at nananatili itong nakalaylay na hindi mo kayang ituwid nang mag-isa.

Karamihan sa mga pinsalang ito ay nagmumula sa isang jamming force, tulad ng pagkasabit ng dulo ng daliri sa kumot o pagtama ng bola sa isang nakadiretsong daliri at biglaang pagbaluktot sa dulo ng joint. Mas madalang, ang isang malakas na over-straightening force ay bumabasag ng mas malaking piraso ng buto mula sa base ng huling buto. Kapag ang nabasag na pirasong iyon ay kinasasangkutan ng ikatlo o higit pa ng joint surface, karaniwang pinapayuhan ang operasyon. Pinapayuhan din ito kapag ang huling buto ay naalis sa linya patungo sa palad, dahil ang joint ay hindi na nakapwesto kung saan ito dapat naroroon.

Ang paglaylay na napansin mo sa seksyon sa itaas ay direktang resulta ng nawalang anchor na ito. Ang isa pang epekto ay maaaring sumunod paitaas sa daliri: dahil ang dulo ng joint ay nakabara sa nakabaluktot na posisyon, ang balanse ng straightening at bending forces sa natitirang bahagi ng daliri ay nagbabago, kung kaya't ang ilang daliri ay nagkakaroon ng over-straight na middle joint.

Mayroong dalawang malawak na pattern. Sa isa, ang tendon lamang ang napunit. Sa isa pa, may kasamang piraso ng buto na natanggal, at ang dalawa ay halos magkamukha mula sa labas dahil ang tendon ay sumasama sa fragment. Karamihan sa mga mallet finger, anuman ang pattern, ay gumagaling gamit ang isang splint na pinapanatiling tuwid ang dulo ng joint lamang. Ang operasyon ay inilalaan para sa mas malalaking fracture, para sa mga joint na naalis sa linya, o para sa mga daliri kung saan hindi gumana ang naunang gamutan.

Ano ang maaari naming gawin tungkol dito

Si Dr Kieran Hirpara, isang upper-limb surgeon sa Mater Private Hospital Rockhampton, ay itinutugma ang gamutan sa iyong partikular na pinsala. Ang mga pasyente ay karaniwang nirerefer sa aming klinika ng kanilang GP; kung iminungkahi ng isang physiotherapist na magpatingin sa amin, kakailanganin mo pa rin ng referral mula sa iyong GP upang maging eligible para sa Medicare rebate. Sa pagbisitang iyon, kumukuha kami ng history, sinusuri ang daliri at nag-aayos ng X-ray kung kinakailangan, upang suriin kung may piraso ng buto na natanggal at kung nakalinya pa rin ang joint.

Para sa karamihan ng mga mallet finger, ang unang hakbang ay isang splint na pinapanatiling diretso ang dulo ng joint. Karaniwan naming hinihiling na isuot ito sa loob ng 6 hanggang 8 linggo, pananatilihin itong suot araw at gabi, at iwasan ang sport o aktibidad na nagdulot ng pinsala habang naka-splint. Isang hand therapist ang nagkakabit ng splint at nagtuturo sa iyo kung paano ito isuot nang hindi naiirita ang balat, at maaaring pamahalaan ang marami sa mga pinsalang ito mula simula hanggang dulo. Kung ang tendon ay napunit na sa loob ng 2 hanggang 4 na linggo bago ka humingi ng tulong, ang splinting ay gumagana pa rin nang halos kasing husay ng kapag ang daliri ay ginamot sa unang 2 linggo, at kahit ang daliring ni-splint 12 linggo matapos ang pinsala ay maaaring gamutin sa halos parehong paraan gaya ng isang bagong pinsala. Ang ilang mga tao ay kailangang panatilihing suot ang splint nang higit sa 12 linggo, at kung gaano ka katagal magpapatuloy ay nakadepende nang malaki sa iyong komportable rito. Ang night splint sa ibabaw ng day splint ay walang naidaragdag, kaya hindi namin hinihiling na pagdoblehin mo ito. Ang uri ng splint, custom-made o ready-made, ay hindi gaanong mahalaga kaysa sa pagsusuot nito ayon sa itinagubilin.

Ang mga pain tablet at anti-inflammatories ay hindi gamutan para sa mismong paglaylay (droop). Maaari nilang pagaanin ang hapdi sa mga unang araw habang ginagawa ng splint ang trabaho nito.

Isinasaalang-alang ang operasyon kapag hindi gumana ang splint, kapag ang paglaylay ay pumipigil sa iyong pagtatrabaho o pagtugon sa isang partikular na pangangailangan, o kapag ang pinsala ay kinasasangkutan ng isang malaking piraso ng joint surface o ang joint ay nadulas patungo sa palad. Ang operasyon ay kinukumpuni o muling ikinakabit ang straightening tendon, o ibinabalik ang bone fragment sa kinalalagyan nito, at ang daliri ay pinapanatiling diretso gamit ang isang maliit na wire at isang splint habang ito ay gumagaling. Pag-uusapan namin ang mga opsyon kasama mo at magpapasya nang magkasama kung ang operasyon ay angkop para sa iyong daliri at sa iyong mga layunin.

Ano ang dapat asahan

Para sa karamihan ng mga tao, ang mallet finger ay gumagaling sa pamamagitan ng gamutan sa halip na operasyon. Ang splint na nagpapanatiling diretso sa dulo lamang ng joint ang karaniwang paraan, at gumagana ito para sa karamihan ng mga pinsala, putol man ang tendon lamang o may kasamang maliit na piraso ng buto na natanggal. Parehong nagbubunga ng mabuting resulta ang splinting at operasyon, kaya maaari kang asahan ang isang diretso at gumaganang dulo ng daliri kapag ang daliri ay nagamot nang maayos.

Ang timing ang nagtatakda kung paano mararamdaman ang paggaling. Kapag ang daliri ay nilagyan ng splint sa loob ng dalawang linggo matapos ang pinsala, kakaunti ang mga taong naiiwang may permanenteng kapansanan. Kung ang tendon ay putol na sa loob ng 2 hanggang 4 na linggo bago ka humingi ng tulong, gumagana pa rin ang splinting nang halos kasing husay, at kahit ang daliring nilagyan ng splint 12 linggo matapos ang pinsala ay maaaring gamutin sa halos parehong paraan gaya ng isang bagong pinsala. Ang ilang mga tao ay kailangang panatilihin ang splint nang higit sa 12 linggo, at kung gaano ka katagal magpapatuloy ay nakadepende nang malaki sa iyong komportable rito.

Kung ang iyong daliri ay hindi nagamot, karaniwang nananatili ang paglaylay. Ang dulo ng joint ay maaaring tumigas sa nakabaluktot na posisyon, at ang gitnang joint ay maaaring magkaroon ng over-straightening na inilarawan kanina. Ang ilang mga napabayaang pinsala ay gumagaling pa rin: ang mga tendinous mallet finger na hinayaan ng 2 hanggang 4 na linggo ay may mababang long-term complication rates kapag pinamahalaan nang walang operasyon, at ang mga kaso ng large-fragment na pinamahalaan nang conservatively ay mayroon ding mababang complication rates. Ngunit ang paghihintay ay ginagawang hindi gaanong predictable ang resulta, kaya mahalaga ang maagang splinting.

Ang operasyon ay inilalaan para sa mas maliit na grupo ng mga daliri kung saan hindi gagana ang splint, gaya ng mas malalaking fracture o joint na nawala sa linya. Mahalagang malaman na ang operasyon sa mga fracture na ito ay may complication rate na 41%, bahagya dahil ang straightening tendon ay manipis at may mahinang supply ng dugo. Gayunpaman, ang operasyong ginawa nang huli para sa mga bony mallet finger ay nagpakita ng minimal na complications. Titimbangin ng iyong surgeon ang mga puntong ito kasama ka sa halip na ipilit ang isang paraan.

Walang iisang splint na napatunayang mas mabuti kaysa sa iba, custom-made man o ready-made. Ang mahalaga ay ang pagsusuot nito ayon sa itinuro, na siyang bahaging kontrolado mo.

Kailan dapat magpatingin

Ang paglaylay ng dulo ng daliri pagkatapos ng isang impact ay dapat ipasuri sa loob ng ilang araw, hindi linggo. Ang maagang paglalagay ng splint ay nagbibigay ng pinakamahusay na pagkakataon para sa isang tuwid at gumaganang daliri, kaya humingi ng referral sa iyong GP para sa isang hand surgeon sa sandaling mapansin mo ang paglaylay. Ganoon din kung ang dulo ng joint ay namamagâ, may pasa o maselan at hindi na maitutuwid.

May ilang mga warning sign na mas mahalaga kaysa sa iba. Kung may piraso ng buto na nabali at kasama ang surface ng joint, ang daliri ay maaaring kumalas sa linya patungo sa palad. Ang mas malaking fracture, o ang mga nakita nang huli, ay nagpapataas ng panganib na iyon. Humingi ng pagsusuri ng isang espesyalista kung ang dulo ng daliri ay kitang-kitang wala sa tamang posisyon, o kung ang gitnang joint ay nagsisimulang yumuko pabalik habang lumalaylay ang dulo.

Pumunta sa emergency department kung ang daliri ay mabilis na nagiging mas masakit, mainit, mapula o namamagâ, o kung hindi mo ito maigalaw nang husto pagkatapos ng isang malakas na pinsala.

Higit pang detalye

Advanced reading: the deeper science (optional)

Ang seksyong ito ay higit pa sa kailangan mo para sa iyong sariling mga desisyon sa paggamot. Ang mallet finger ay karapat-dapat sa karagdagang pagbabasa dahil ang dalawang sitwasyon na karaniwang itinuturing na malinaw na indikasyon para sa operasyon — isang malaking fracture fragment, at isang nananatiling paglaylay pagkatapos ng splinting, ay hindi kasinglinaw ng kumpiyansang ginagamit sa pagpapahayag ng mga ito.

Parehong nagbibigay ng mabuting resulta ang mga gamutan, at walang nakakaalam kung nasaan ang hangganan

Ang isang systematic review ng surgical at non-surgical management ay nakarating sa isang konklusyon na hindi pangkaraniwang direkta: parehong humahantong sa mabuting clinical outcomes, at hindi sapat ang ebidensyang available upang matukoy kung kailan indicated ang surgical intervention [1].

Ang ikalawang bahagi ang mahalaga. Ang pagtatalo ay hindi tungkol sa kung gumagana ang alinman sa mga gamutan. Ito ay dahil ang threshold para sa pagpili ng surgery, ang punto kung saan ang fracture ay hinuhusgang masyadong malaki, o ang joint ay masyadong subluxed, ay nakabatay sa convention sa halip na sa comparative evidence.

Kung saan ang fragment ay kinasasangkutan ng higit sa isang katlo ng joint surface, o ang distal phalanx ay na-sublux, ang surgery ay karaniwang indicated, ngunit ang isang makabuluhang bentahe ng surgical management, kahit sa mga komplikadong kasong iyon, ay hindi pa malinaw na napatutunayan [2].

Gumagana ang splinting, at ang mahalagang numero ay kung gaano ito katagal

Mas konkreto ang ebidensya sa orthotic. Dalawa sa tatlong pag-aaral ang nakatagpo ng malaking effect size para sa orthotic intervention, na naglalaro mula 2.17 hanggang 12.12, na may inirerekomendang tagal ng immobilisation na 6 hanggang 8 linggo, at karagdagang mga linggo kung nananatili ang lag [3].

May dalawang praktikal na punto na kasunod. Ang una ay dapat panatilihin ng splint na diretso ang dulo ng daliri nang tuloy-tuloy, ang mga dulo ng tendon ay pinapanatiling magkadikit sa pamamagitan ng posisyon lamang, at ang ilang minuto ng flexion habang naghuhugas ay nag-uumpisa muli ng oras. Ang ikalawa ay ang "karagdagang mga linggo kung nananatili ang lag" ay bahagi ng protocol, hindi isang tanda ng pagkabigo.

Bakit madalas na katanggap-tanggap ang residual droop

Karaniwan ang maliit na permanenteng extension lag pagkatapos ng gamutan, at ito ay karaniwang compatible sa normal na paggamit ng kamay. Ang distal joint ay may relatibong maliit na kontribusyon sa grip, at karamihan sa mga tao ay nakaka-adapt sa ilang digri ng droop nang hindi ito napapansin sa aspetong functional.

Mahalaga ito kapag tinitimbang ang operasyon para sa isang hindi perpektong resulta, dahil ang pag-oopera sa joint na ito ay may kaakibat na kapalit: maliit ang fragment, manipis ang balat, at ang pin o wire fixation ng joint na may ganitong laki ay may mga panganib ng impeksyon, nail deformity, at joint stiffness na dapat itimbang laban sa isang cosmetic-to-mild functional gain. Dahil ang mga review sa itaas ay hindi makapagpakita ng kalamangan para sa operasyon kahit sa mga komplikadong kaso, ang pagtanggap sa isang modest lag ay isang pagpipiliang consistent sa ebidensya sa halip na isang kompromiso.

Ang depermidad na hindi mallet finger

Ang mallet finger ay isa sa pamilya ng mga closed extensor mechanism injuries, na nakikilala pangunahin sa kung saan sa tendon nangyayari ang pagkaputol, mallet sa dulo ng daliri, boutonnière sa gitnang joint, at sagittal band injury sa knuckle [4]. Madalas silang mapagkamalan sa isa't isa sa simula, kapag tinatakpan ng pamamaga ang pattern, at ang bawat isa ay may magkaibang posisyon ng splinting. Ang pag-splint sa boutonnière na tila ito ay isang mallet ay humahawak sa maling joint, kung kaya't mahalagang kumpirmahin ang diagnosis bago maglaan ng anim na linggo ng immobilisation.

Mga Sanggunian

[1] Lin JS, Samora JB. Surgical and nonsurgical management of mallet finger: a systematic review. J Hand Surg Am. 2018;43(2):146-163.e2. https://doi.org/10.1016/j.jhsa.2017.10.004

[2] Lamaris GA, Matthew MK. The diagnosis and management of mallet finger injuries. Hand (N Y). 2016;12(3):223-8. https://doi.org/10.1177/1558944716642763

[3] Valdes K, Naughton N, Algar L. Conservative treatment of mallet finger: a systematic review. J Hand Ther. 2015;28(3):237-46. https://doi.org/10.1016/j.jht.2015.03.001

[4] Lin JD, Strauch RJ. Closed soft tissue extensor mechanism injuries (mallet, boutonniere, and sagittal band). J Hand Surg Am. 2014;39(5):1005-11. https://doi.org/10.1016/j.jhsa.2013.11.018

Evidence & references

This is the clinical evidence summary written for health professionals. It is technical, and it lists the research this page was built from. You do not need to read it to understand your treatment or to make a decision about it.

Overview

Most mallet finger injuries can be managed non-surgically with splinting [5].
Surgery is occasionally recommended for acute or chronic cases of mallet finger [5].
Surgery is occasionally recommended for salvage of failed prior treatment in mallet finger cases [5].
Both surgical and nonsurgical treatments of mallet finger injuries lead to excellent clinical outcomes [2].
After a mallet-finger injury treated within two weeks by either internal or external splintage, few patients have significant persistent disability [7].
Today most authorities splint only the distal joint for mallet finger deformities [9].
There was insufficient evidence from comparisons tested within randomised controlled trials to establish the relative effectiveness of different custom-made or off-the-shelf finger splints used for treating mallet finger injury [10].
The authors propose to treat all cases of mallet finger with a dorsal glued splint except for stage IV mallet finger [8].
Stage IV mallet finger is treated with extra-articular pinning according to the proposed protocol in [8] [8].
A simple splint is recommended as an alternative means of treating mallet finger [16].
Delayed surgical management of bony mallet fingers demonstrated adequate functional outcome with minimal complications when compared with prior literature [1].
Complication rates were low, suggesting that large-fragment mallet finger cases can be effectively managed conservatively [4].
Absolute indications for surgical intervention for mallet fingers in the pediatric population remain unclear [3].
The role of surgery for mallet fractures of the thumb remains unclear due to their uncommon nature and favorable radiographic findings [6].
Surgery is generally indicated in the case of mallet fractures involving more than one-third of the articular surface [17].
Surgery is generally indicated in all patients who develop volar subluxation of the distal phalanx [17].
A significant advantage of surgical management even in complicated cases of mallet finger has yet to be clearly proven [17].

Anatomy & Pathophysiology

Mechanism of Injury

Mallet finger most commonly involves a closed rupture of the terminal tendon with or without associated fracture of the distal phalanx [34].
The usual mechanism of injury involves sudden passive flexion of the actively extended distal interphalangeal joint [21].
Snagging the extending finger on a pants cuff, a bedsheet, or other object that suddenly flexes the extending DIP joint is a frequent cause of mallet finger [34].
Less commonly, a forceful hyperextension injury of the DIP joint may result in a large fracture of the base of the distal phalanx involving one-third or more of the articular surface [34].
Open mallet injuries are uncommon [34].
The direction of force on the fingertip that results in a mallet fracture has yet to be determined [47].
The precise mechanism of injury leading to different sizes of mallet fracture fragments might be difficult to delineate due to multiple variables, including tendon tension at the time of injury and the strain-rate-dependent mechanical properties of the affected bone and soft tissues [47].

Pathophysiology

Mallet finger involves loss of continuity of the extensor tendon over the distal interphalangeal joint [14].
Mallet finger reflects the loss of normal extensor force transmission via the terminal tendon insertion onto the distal phalanx [21].
The unopposed flexor digitorum profundus pulls the distal joint into flexion [21].
Mallet finger injuries may lead to an imbalance between flexion and extension forces more proximally in the digit [14].
Disruption of the terminal tendon may be entirely confined to the tendon or may involve an avulsed fracture fragment from the dorsal lip of the distal phalanx proximal articular surface [21].
Because the avulsed fragment includes the terminal tendon insertion, the clinical appearance of soft tissue and bony mallet fingers is similar [21].
The distal joint rests in flexion, a posture that cannot be actively changed [21].
Full passive extension of the distal interphalangeal joint is possible in mallet finger [21].
Distal interphalangeal joint subluxation is expected with a mallet fracture fragment involving more than one-half of the joint surface [47].
The distal interphalangeal joint has a remarkable ability to remodel [47].

Incidence and Demographics

The most frequently involved digits are the small, ring, and middle fingers of the dominant hand, with a male predominance [34].
Tendinous mallet fingers have been reported to occur from age 11 onward [34].
In skeletally immature individuals, a transepiphyseal plate fracture may be seen [34].
There may be a familial predisposition to mallet fingers [34].
Elderly patients with osteoarthritis of the DIP joint may have “mallet” deformities that are not related to trauma [34].
Individuals with hyperlax joints may have multiple pseudomallet swan neck postures that are unrelated to trauma [34].

Classification

The Doyle classification system describes four types of mallet finger injuries [56].
In the Doyle classification, Type IV represents mallet fractures and is further broken into three subtypes according to the size of articular involvement [56].
The Wehbé and Schneider classification describes DIP joint subluxation and epiphyseal and physeal injuries [56].
In the Wehbé and Schneider classification, articular injuries are subdivided into type A (less than one-third), type B (between one-third and two-thirds), and type C (larger than two-thirds of the joint) [56].
The Doyle and Wehbé and Schneider classification schemes aid in standardizing injury patterns and guiding treatment algorithms [56].
A 2023 review proposes a modification to the Doyle classification to make it more encompassing and less prone to interobserver error [26].
The modified Mallet classification demonstrated strong to excellent agreement and interrater reliability across face-to-face, live tele-assessment, and video-based conditions [45].
The modified Mallet classification is suggested to be appropriate for remote medical follow-up based on its reliability across assessment conditions [45].
The interrater reliability of the Kellgren & Lawrence and OARSI classification systems for post-traumatic osteoarthritis in the distal interphalangeal joint after mallet finger fractures is considerably lower than initially assumed [44].

Clinical Presentation

Mallet finger results in a flexion deformity of the distal finger joint [14].
Mallet finger may lead to an imbalance between flexion and extension forces more proximally in the digit [14].
Mallet injuries can be classified into four types based on skin integrity and the presence or absence of bony involvement [14].
Mallet deformity accounts for a minority of sporting injuries [19].
Mallet finger injuries are frequent in football [23].
Mallet finger injuries are difficult to treat during the competitive season, often requiring delayed treatment or internal splinting [23].
Early recognition of mallet finger injuries and referrals to a hand surgeon for treatment are crucial to avoid longterm disability [18].
Approximately 50% of patients with a mallet fracture involving more than one-third of the articular surface of the distal phalanx do not progress to subluxation of the DIP joint [39].
Fracture size and time to application of finger immobilizer are independent risk factors for the development of DIP joint subluxation in mallet fracture [39].

Investigations

A radiograph should be obtained to determine whether a fracture is present [21].
Radiographs should determine if the dorsal fragment is large and whether the distal phalanx is subluxed palmarward [21].

Treatment

Non-Operative Management

Splinting of the distal interphalangeal joint for 6 to 8 weeks has yielded good results while minimizing morbidity in the majority of patients [14].
Non-operative management of mallet fractures, regardless of fracture classification, joint congruence or pre-existing degenerate change in the DIP joint, is safe and yields predictably good outcomes in most patients [15].
Conservative management of tendinous mallet finger injuries that have been neglected for 2 to 4 weeks can be treated as well as those injuries in patients presenting within the first 2 weeks of injury with low long-term complication rates [12].
A mallet finger caused by avulsion of the extensor tendon from the distal phalanx can be satisfactorily treated by splinting 12 weeks after injury, as described for an acute injury [13].
Prolonged splinting and splinting longer than 12 weeks may be successful, with the duration limited by the patient’s tolerance of the splinting [13].
Supplemental night splinting does not improve the outcome of mallet finger in terms of extensor lag, disability, or satisfaction with treatment [24].
There was insufficient evidence from comparisons tested within randomised controlled trials to establish the relative effectiveness of different, either custom-made or off-the-shelf, finger splints used for treating mallet finger injury [10].
Excellent functional outcome can be achieved with splintage and avoidance of the causative sport while splinted [19].
A hand therapist can treat type 1 mallet finger injuries as effectively as a surgeon [27].
A hand therapist can treat mallet finger injuries of type 1 as effectively as a surgeon, with a method of immobilisation that offers practically no complications regarding skin condition [40].
Large-fragment mallet finger cases can be effectively managed conservatively with low complication rates [4].
The clinical efficacy of elastic taping for the treatment of mallet finger injuries remains to be tested vigorously [37].
Conventional treatment protocols usually recommend 6 weeks of immobilization in a neutral or slightly flexed splint, followed by staged mobilization [33].
Giddins (2022) suggested that only 3-4 weeks of immobilization for bony mallet injuries is sufficient, reflecting faster bone healing [33].
A retrospective study examined outcomes of acute bony mallet injuries treated with 4 weeks of static immobilization in a splint, followed by graduated mobilization [33].

Operative Management

Surgery is occasionally recommended for acute or chronic cases or for salvage of failed prior treatment [5].
Surgical management may be considered for acute and chronic mallet lesions in patients who have failed nonsurgical treatment, are unable to work, or have specific functional needs [14].
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 [17].
A significant advantage of surgical management even in complicated cases (fractures >1/3 articular surface or volar subluxation) has yet to be clearly proven [17].
If the distal phalanx droops severely but passive extension in the distal interphalangeal joint is still satisfactory, surgery may be indicated depending on the patient’s needs [13].
Scar overlapping suture for treating chronic tendinous mallet finger in children is safe and effective [41].
A deepithelialised pedicled skin flap technique seems to be a new reliable alternative in the treatment of chronic mallet finger [46].

Surgical Techniques and Postoperative Care

For secondary repair of chronic mallet finger, a small V-shaped or U-shaped incision is made convex distally, with the tip no closer than 5 mm proximal to the nail base on the dorsum of the finger [13].
The surgical flap is developed in the plane between the tendon and the subcutaneous fat and elevated proximally to expose the extensor tendon with its intervening scar [13].
The junction of the normal tendon with the scar is identified, and the tendon is severed transversely proximal to the joint, leaving the insertion of the tendon into bone [13].
Sufficient scar or tendon is resected to allow closure of the gap with the finger in maximal extension [13].
The joint is immobilized with a transarticular 0.045-inch Kirschner wire to support and protect the repair [13].
The extensor tendon is repaired with 4-0 monofilament nylon or 4-0 monofilament wire as a pull-out roll stitch, with no additional sutures required [13].
The skin is closed with interrupted 5-0 nylon or 4-0 nylon as a dermotondermal suture [13].
The finger is maintained in extension with a compressive dressing and supported with a volar splint for post-operative comfort and to avoid reinjury [13].
Sutures are removed at 10 to 14 days, and the distal joint is maintained in extension with the Kirschner wire protected by a small metal splint for 4 weeks [13].
The Kirschner wire is removed after 4 to 6 weeks, and the repair is protected with a splint for 8 weeks [13].
Normal activities are progressively resumed after the splinting period [13].

Complications

The complication rate after operative treatment of mallet fracture was 41% [51].
The high complication rate after operative treatment of mallet fracture is likely attributable to anatomical factors such as thin extensor tendon and poor blood supply [51].
Delayed surgical management of bony mallet fingers demonstrated minimal complications [1].
Conservative management of tendinous mallet finger injuries neglected for 2 to 4 weeks has low long-term complication rates [12].
A surgical technique for acute combined tendon and bone mallet fingers reported no complications such as infection, nonunion, or nail deformity in the series [29].
Complication rates were low in large-fragment mallet finger cases managed conservatively [4].

Recovery

Most mallet finger injuries can be managed non-surgically with splinting, although surgery is occasionally recommended for acute or chronic cases or for salvage of failed prior treatment [5].
The authors propose to treat all cases of mallet finger with a dorsal glued splint except for stage IV mallet finger, which they treat with extra-articular pinning [8].
Most authorities splint only the distal joint for mallet finger deformities [9].
Mallet finger injuries are frequent in football and difficult to treat during the competitive season, often requiring delayed treatment or internal splinting [23].

Key Evidence

[L4] Delayed surgical management of bony mallet fingers demonstrated adequate functional outcome with minimal complications when compared with prior literature. [1] (10.1177/1558944719840749)
[L4] Both surgical and nonsurgical treatments of mallet finger injuries lead to excellent clinical outcomes. [2] (10.1016/j.jhsa.2017.10.004)
[L4] Absolute indications for surgical intervention for mallet fingers in this population remain unclear. [3] (10.1016/j.jhsa.2018.03.037)
[L4] Complication rates were low, suggesting that large-fragment mallet finger cases can be effectively managed conservatively. [4] (10.1186/s12891-026-09787-w)
[L5] Most mallet finger injuries can be managed non-surgically with splinting, although surgery is occasionally recommended for acute or chronic cases or for salvage of failed prior treatment. [5] (10.1007/s11552-014-9609-y)
[L3] The role of surgery for mallet fractures of the thumb remains unclear due to their uncommon nature and favorable radiographic findings. [6] (10.1177/1558944716672192)
[L1] After a mallet-finger injury treated within two weeks by either method few patients have significant persistent disability. [7] (10.1016/s0072-968x(82)80011-9)
[L5] The authors propose to treat all cases of mallet finger with a dorsal glued splint except for stage IV mallet finger, which they treat with extra-articular pinning. [8] (10.5999/aps.2016.43.2.134)
[L5] Today most authorities splint only the distal joint for mallet finger deformities. [9] (10.1016/s0749-0712(21)00059-7)
[L1] There was insufficient evidence from comparisons tested within randomised controlled trials to establish the relative effectiveness of different, either custom-made or off-the-shelf, finger splints used for treating mallet finger injury. [10] (10.1002/14651858.cd004574.pub2)
[L3] Conservative management of tendinous mallet finger injuries that have been neglected for 2 to 4 weeks can be treated as well as those injuries in patients presenting within the first 2 weeks of injury with low long-term complication rates. [12] (10.1016/j.jhsa.2014.06.140)
[L5] [14] (10.5435/00124635-200509000-00007)
[L3] Non-operative management of mallet fractures, regardless of fracture classification, joint congruence or pre-existing degenerate change in the DIP joint, is safe and yields predictably good outcomes in most patients. [15] (10.1177/1753193421992986)
[L2] The study recommends this splint as an alternative means of treating mallet finger. [16] (10.1136/emj.10.3.244)
[L4] 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. [17] (10.1177/1558944716642763)
[L4] Early recognition of these injuries and referrals to a hand surgeon for treatment are crucial to avoid longterm disability. [18] (10.1016/j.hcl.2012.05.042)
[L4] Mallet deformity accounts for a minority of sporting injuries, but excellent functional outcome can be achieved with splintage and avoidance of the causative sport while splinted. [19] (10.1054/jhsb.2000.0484)
[L5] Mallet finger injuries are frequent in football and difficult to treat during the competitive season, often requiring delayed treatment or internal splinting. [23] (10.1016/j.hcl.2012.05.043)
[L1] Supplemental night splinting does not improve the outcome of mallet finger in terms of extensor lag, disability, or satisfaction with treatment. [24] (10.1007/s11552-013-9600-z)
[L4] [26] (10.1016/j.jhsa.2022.10.013)
[L4] A hand therapist can treat type 1 mallet finger injuries as effectively as a surgeon. [27] (10.1197/j.jht.2008.04.002)
[L4] The study describes a surgical technique for acute combined tendon and bone mallet fingers and reports good to excellent long-term results with no reported complications such as infection, nonunion, or nail deformity in the series. [29] (10.1016/j.jhsa.2014.11.011)
[L4] [33] (10.1177/17531934251382017)
[L4] Most fingers ended with a dorsal prominence, but this did not significantly affect function. [34] (10.2106/00004623-198466050-00003)
[L4] The clinical efficacy of the proposed method of elastic taping for the treatment of mallet finger injuries remains to be tested vigorously. [37] (10.1016/j.jht.2014.02.005)
[L2] Approximately 50% of patients with a mallet fracture involving more than one-third of the articular surface of the distal phalanx do not progress to subluxation of the DIP joint; fracture size and time to application of finger immobilizer are independent risk factors for the development of DIP joint subluxation in mallet fracture. [39] (10.1177/1753193414554556)
[L4] A hand therapist can treat mallet finger injuries of type 1 as effectively as a surgeon, with a method of immobilisation that offers practically no complications regarding skin condition. [40] (10.1177/175899830501000103)
[L4] Scar overlapping suture for treating chronic tendinous mallet finger in children is safe and effective. [41] (10.1186/s13018-019-1106-0)
[L4] The interrater reliability of the Kellgren & Lawrence and OARSI classification systems for post-traumatic osteoarthritis in the distal interphalangeal joint after mallet finger fractures is considerably lower than initially assumed. [44] (10.1016/j.jhsa.2024.03.012)
[L3] The modified Mallet classification demonstrated strong to excellent agreement and interrater reliability across face-to-face, live tele-assessment, and video-based conditions, suggesting it is appropriate for remote medical follow-up. [45] (10.1177/17531934231196118)
[Paper] This method seems to be a new reliable alternative in the treatment of chronic mallet finger. [46] (10.1016/j.injury.2013.01.013)
[L5] [47] (10.1016/j.jhsa.2008.04.014)
[L4] The complication rate after operative treatment of mallet fracture was 41%, likely attributable to anatomical factors such as thin extensor tendon and poor blood supply. [51] (10.1054/jhsb.2000.0440)
[L5] [56] (10.1177/1753193414554772)

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