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锤状指 资料 In-depth

本页面由机器翻译，尚未经临床医生审核。英文版本为权威版本。

您的症状

锤状指表现为手指末端关节下垂，您无法自行将指尖伸直。手指可能在最靠近指甲的最后一个关节处呈现弯曲状态。这种损伤发生在伸直该关节的肌腱撕裂或从附着点撕脱时，有时还会伴有一小块骨片。

末端关节通常触痛，在受伤后的几天内可能出现肿胀或瘀伤。将指尖推直、握球或敲击手指可能会加重疼痛。让手指保持静止，并用夹板支撑，通常可以缓解症状。

在日常生活中，下垂的指尖会妨碍精细动作。由于指尖无法推直，捡硬币、扣小纽扣、打字或握笔时可能会感到笨拙。球类运动是导致这种损伤的常见原因，比赛中手指被撞击往往是其起始诱因。

部分手指还会在手指更近端的位置出现第二个问题。当末端关节下垂时，中间关节可能会开始过度伸直或向后弯曲。如果您注意到这种情况，请提及，因为这会改变手指的治疗方案。

有一件事比几乎其他任何事情都更重要：时机。尽早让医生检查并固定手指，理想情况下在受伤后两周内，能获得指尖伸直且功能正常的最佳机会。拖延可能导致永久性僵硬或关节对位不良。如果您的手指已经下垂了一段时间，仍然值得进行检查，因为对于未接受治疗的手指也有相应的处理选项。

您不需要猜测病情的严重程度。在受到撞击后出现指尖下垂，就足以成为接受评估的理由，以便在关节发生变化之前开始正确的夹板固定或治疗。

实际发生了什么

您的指尖能够伸直，是因为一根由强韧纤维组成的细腱索沿手指背面走行，并锚定在最后一节指骨上。在锤状指中，这根腱索会断裂或从其锚定点撕脱，有时还会带走一小块骨片。末端关节无法再从背面被推直，因此弯曲该关节的肌腱会将其向下牵拉，使其停留在您无法自行纠正的下垂位置。

大多数此类损伤源于挤压力，例如指尖被床单勾住，或球体撞击伸直的指头并突然弯曲末端关节。较少见的情况是，强烈的过度伸直力会将最后一节指骨基底部的较大骨块撕脱。当该骨折块累及关节面三分之一或以上时，通常建议进行手术。此外，当最后一节指骨向掌侧移位、关节不再处于正常位置时，通常也建议手术。

您在上述部分注意到的下垂，正是这种锚定结构丧失的直接结果。手指更近端可能还会受到进一步影响：当末端关节卡在屈曲位置时，整个手指伸直与屈曲力量的平衡会发生改变，这就是为什么有些手指会出现中间关节过度伸直的情况。

主要有两种模式。一种是仅肌腱撕裂；另一种是肌腱撕裂时带有一块骨片，由于肌腱随骨折块移位，两者从外观上看非常相似。大多数锤状指，无论哪种模式，都可以通过仅固定末端关节于伸直位的支具得到稳定。手术通常保留给较大的骨折、关节脱位或先前治疗无效的病例。

我们如何处理

Mater Private Hospital Rockhampton 的上肢外科医生 Kieran Hirpara 医生会根据您的具体伤情制定治疗方案。患者通常由全科医生（GP）转诊至我们的诊所；如果物理治疗师建议您就诊，您仍需获得全科医生的转诊，才有资格享受 Medicare 报销。在就诊时，我们会采集病史，检查手指，并在必要时安排 X 光检查，以确认是否有骨片脱落以及关节是否对位。

对于大多数锤状指，第一步是使用仅固定远端关节使其保持伸直位的支具。我们通常要求您佩戴 6 至 8 周，白天和夜间均需佩戴，并在佩戴支具期间避免导致受伤的运动或活动。手部治疗师会为您适配支具，并指导您如何佩戴以避免刺激皮肤，并且可以从始至终管理此类损伤。如果在受伤后 2 至 4 周才寻求帮助，支具治疗的效果通常与在受伤后最初 2 周内治疗的效果相当，甚至在受伤 12 周后佩戴支具的手指，其治疗方式也可与新鲜损伤基本相同。有些人需要佩戴支具超过 12 周，继续佩戴的时间主要取决于您佩戴时的舒适度。在日间支具之上加用夜间支具并无额外益处，因此我们不会要求您双重佩戴。支具的类型（定制或现成）不如按照指示佩戴重要。

止痛药和抗炎药并不是针对下垂本身的治疗。它们可能在最初几天缓解疼痛，而支具则发挥其作用。

当支具治疗无效、下垂妨碍您工作或满足特定需求，或损伤涉及大块关节面或关节向掌侧脱位时，会考虑手术。手术旨在修复或重新附着伸直肌腱，或将骨片复位固定，随后用细钢丝和支具将手指保持伸直位直至愈合。我们会与您讨论各种选择，并共同决定手术是否适合您的手指及您的目标。

预期情况

对于大多数人来说，锤状指通过保守治疗而非手术即可恢复。仅固定末端关节使其保持伸直位的支具是常规治疗路径，对于大多数损伤均有效，无论是单纯肌腱撕裂还是伴有小骨片撕脱。支具固定和手术均可取得良好效果，因此只要手指得到适当治疗，您可以预期指尖能够伸直并正常活动。

时机决定了恢复过程的感受。如果在受伤后两周内对手指进行支具固定，很少有人会遗留永久性功能障碍。如果肌腱撕裂后 2 至 4 周才寻求帮助，支具固定的效果通常依然良好，甚至在受伤 12 周后固定手指，其处理方式也与新鲜损伤大致相同。有些人需要佩戴支具超过 12 周，继续佩戴的时间长短主要取决于您对其舒适度的接受程度。

如果手指未接受治疗，下垂通常持续存在。末端关节可能在屈曲位发生僵硬，而中间关节可能出现前文所述的过度伸直。部分被忽视的损伤预后仍然良好：未手术处理的腱性锤状指，若遗留 2 至 4 周，其长期并发症发生率较低；保守治疗的大骨片病例并发症发生率也较低。但等待会使预后变得不可预测，这正是早期支具固定至关重要的原因。

手术仅保留给支具无法解决问题的那部分较小群体，例如较大的骨折或关节脱位。值得注意的是，此类骨折的手术并发症发生率为 41%，部分原因在于负责伸直的肌腱较薄且血供较差。然而，针对骨性锤状指后期进行的手术已显示出极低的并发症率。您的外科医生会与您权衡这些因素，而不是强行推荐某一种治疗路径。

没有证据表明某种支具（定制或现成）优于另一种。关键在于按照指示佩戴支具，这是您能够控制的部分。

何时就医

手指受到撞击后出现下垂，应在数日内而非数周内进行检查。早期夹板固定能为手指恢复笔直和功能提供最佳机会，因此一旦发现下垂，请立即请您的全科医生转诊至手外科医生。如果末端关节肿胀、瘀伤或压痛且无法伸直，同样适用此建议。

某些警示信号比其他信号更为重要。如果一块骨头断裂且累及关节面，手指可能向手掌方向脱位。较大的骨折或发现较晚的骨折会增加这种风险。如果指尖明显错位，或当指尖下垂时中间关节开始向后弯曲，请要求专家评估。

如果手指在强力损伤后疼痛迅速加剧、发热、发红或肿胀，或者完全无法活动，请前往急诊科。

深入探讨

Advanced reading: the deeper science (optional)

本节内容超出了您做出自身治疗决策所需的深度。锤状指值得额外阅读，因为通常被视为手术明确指征的两种情况——较大的骨折碎片以及夹板固定后持续存在的下垂——其确立程度并不像其表述所体现的确定性那样明确。

两种治疗均能取得良好效果，且无人知晓分界线何在

一项关于手术与非手术治疗的系统综述得出了一个异常直接的结论：两者均能带来良好的临床结局，且现有证据不足以确定何时应进行手术干预 [1]。

后半部分才是关键所在。争议并非在于哪种治疗有效，而在于选择手术的阈值——即判断骨折块过大或关节半脱位过重的临界点——目前基于惯例而非比较性证据。

当骨折块累及关节面超过三分之一，或远节指骨发生半脱位时，通常建议进行手术治疗，但即使在那些复杂病例中，手术治疗具有显著优势这一观点尚未得到明确证实 [2]。

夹板固定有效，关键在于固定时长

关于矫形器的证据更为具体。三项研究中有两项发现矫形器干预具有较大的效应量，范围从 2.17 到 12.12，建议的固定时间为 6 至 8 周，若存在滞后现象则需额外延长数周 [3]。

由此得出两个实用要点。第一，夹板必须持续保持指尖伸直，肌腱断端仅靠体位保持对合，清洗时哪怕几分钟的屈曲动作都会使计时重新开始。第二，“若存在滞后现象则需额外延长数周”是治疗方案的一部分，而非治疗失败的迹象。

为何残留的屈曲受限通常是可以接受的

治疗后出现轻微的永久性伸指滞后是常见的，通常与正常的手部功能相容。远端关节对抓握的贡献相对较小，大多数人能适应几度的屈曲受限，且在功能上几乎察觉不到。

在权衡是否对不完美结果进行手术时，这一点至关重要，因为对该关节的手术并非没有代价：骨折块较小，皮肤较薄，且对如此小的关节进行克氏针或钢丝固定存在感染、指甲畸形和关节僵硬的风险，这些风险必须与美容至轻度功能改善的收益相权衡。鉴于上述综述无法证明即使在复杂病例中手术也具有优势，接受适度的滞后是一个符合循证医学的选择，而非妥协。

并非锤状指的畸形

锤状指属于闭合性伸肌腱损伤家族中的一员，其主要区别在于腱断裂发生的具体位置：锤状指位于指尖，钮孔状指位于中间关节，而矢状带损伤位于掌指关节 [4]。在早期，由于肿胀掩盖了损伤模式，这些损伤常被相互混淆，且每种损伤所需的夹板固定位置各不相同。若将钮孔状指误当作锤状指进行夹板固定，会固定错误的关节，这正是为何在承诺进行六周制动之前，值得确认诊断的原因。

参考文献

[1] Lin JS, Samora JB. 锤状指的手术与非手术治疗：系统综述. 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. 锤状指损伤的诊断与治疗. Hand (N Y). 2016;12(3):223-8. https://doi.org/10.1177/1558944716642763

[3] Valdes K, Naughton N, Algar L. 锤状指的保守治疗：系统综述. J Hand Ther. 2015;28(3):237-46. https://doi.org/10.1016/j.jht.2015.03.001

[4] Lin JD, Strauch RJ. 闭合性软组织伸肌机制损伤（锤状指、纽扣畸形及矢状带损伤）. J Hand Surg Am. 2014;39(5):1005-11. https://doi.org/10.1016/j.jhsa.2013.11.018

Reviewed by Kieran Hirpara · 27 April 2026.

Talk to your treating clinician for advice specific to you.

For an appointment with the CQ Hand + Upper Limb team, ask your GP about a referral or visit www.cqupperlimb.com.

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)

References

[1] Delayed Extension Block Pinning in 27 Patients With Mallet Fracture. HAND. 2019. DOI: 10.1177/1558944719840749

[2] Surgical and Nonsurgical Management of Mallet Finger: A Systematic Review. The Journal of Hand Surgery. 2018. DOI: 10.1016/j.jhsa.2017.10.004

[3] Outcomes of Splinting in Pediatric Mallet Finger. The Journal of Hand Surgery. 2018. DOI: 10.1016/j.jhsa.2018.03.037

[4] Surgical versus conservative management of Doyle type 4c mallet finger: a comparative study. BMC Musculoskeletal Disorders. 2026. DOI: 10.1186/s12891-026-09787-w

[5] Current Concepts: Mallet Finger. HAND. 2014. DOI: 10.1007/s11552-014-9609-y

[6] Mallet Fractures of the Thumb Compared With Mallet Fractures of the Fingers. HAND. 2016. DOI: 10.1177/1558944716672192

[7] Mallet-Finger Injuries: A Prospective, Controlled Trial of Internal and External Splintage.. Hand. 1982. DOI: 10.1016/s0072-968x(82)80011-9

[8] Review of Acute Traumatic Closed Mallet Finger Injuries in Adults. Archives of Plastic Surgery. 2016. DOI: 10.5999/aps.2016.43.2.134

[9] EXTENSOR TENDON INJURIES AT THE DISTAL INTERPHALANGEAL JOINT. Hand Clinics. 1995. DOI: 10.1016/s0749-0712(21)00059-7

[10] Interventions for treating mallet finger injuries. Cochrane Database of Systematic Reviews. 2004. DOI: 10.1002/14651858.cd004574.pub2

[12] Soft-Tissue Mallet Injuries: A Comparison of Early and Delayed Treatment. The Journal of Hand Surgery. 2014. DOI: 10.1016/j.jhsa.2014.06.140

[13] Campbell S Operative Orthopaedics 4 Volume Set. RECONSTRUCTION OF FINGER FLEXORS: SINGLE-STAGE TENDON GRAFT > CHRONIC MALLET FINGER (SECONDARY REPAIR).

[14] Mallet Finger. Journal of the American Academy of Orthopaedic Surgeons. 2005. DOI: 10.5435/00124635-200509000-00007

[15] The non-operative management of bony mallet injuries. Journal of Hand Surgery (European Volume). 2021. DOI: 10.1177/1753193421992986

[16] The conservative treatment of mallet finger with a simple splint: a case report.. Emergency Medicine Journal. 1993. DOI: 10.1136/emj.10.3.244

[17] The Diagnosis and Management of Mallet Finger Injuries. HAND. 2016. DOI: 10.1177/1558944716642763

[18] Tendon Ruptures: Mallet, FDP and ECRB Tendon Ruptures Associated with Lunotriquetral Coalitions in Professional Basketball Players. Hand Clinics. 2012. DOI: 10.1016/j.hcl.2012.05.042

[19] Mallet Deformity in Sport. Journal of Hand Surgery. 2001. DOI: 10.1054/jhsb.2000.0484

[21] A Lange Medical Book Current Diagnosis Treatment In Orthopedics Fifth Edition. 9Hand Surgery > 3. Mallet Finger.

[23] Tendon Ruptures: Mallet, FDP in Football. Hand Clinics. 2012. DOI: 10.1016/j.hcl.2012.05.043

[24] A Prospective Randomized Controlled Trial Comparing Night Splinting with No Splinting after Treatment of Mallet Finger. HAND. 2014. DOI: 10.1007/s11552-013-9600-z

[26] Acute Mallet Finger Injuries—A Review. The Journal of Hand Surgery. 2023. DOI: 10.1016/j.jhsa.2022.10.013

[27] Hand Therapist-led Management of Mallet Finger. Journal of Hand Therapy. 2008. DOI: 10.1197/j.jht.2008.04.002

[29] Pullout Wire Fixation Together With Distal Interphalangeal Joint Kirschner Wire Stabilization for Acute Combined Tendon and Bone (Double Level) Mallet Finger Injury. The Journal of Hand Surgery. 2015. DOI: 10.1016/j.jhsa.2014.11.011

[33] Four-week splint with early mobilization protocol for the management of bony mallet injuries. Journal of Hand Surgery (European Volume). 2025. DOI: 10.1177/17531934251382017

[34] Mallet fractures.. The Journal of Bone & Joint Surgery. 1984. DOI: 10.2106/00004623-198466050-00003

[37] A novel way of treating mallet finger injuries. Journal of Hand Therapy. 2014. DOI: 10.1016/j.jht.2014.02.005

[39] The risk factors associated with subluxation of the distal interphalangeal joint in mallet fracture. Journal of Hand Surgery (European Volume). 2014. DOI: 10.1177/1753193414554556

[40] Hand Therapist-led Management of Mallet Finger. The British Journal of Hand Therapy. 2005. DOI: 10.1177/175899830501000103

[41] Scar overlapping suture for treating chronic tendinous mallet finger in children. Journal of Orthopaedic Surgery and Research. 2019. DOI: 10.1186/s13018-019-1106-0

[44] Rater Agreement of Post-Traumatic Osteoarthritis of the Distal Interphalangeal Joint 12 Years After a Mallet Finger Fracture. The Journal of Hand Surgery. 2024. DOI: 10.1016/j.jhsa.2024.03.012

[45] Interrater reliability of face-to-face, tele- and video-based assessments with the modified Mallet classification in brachial plexus birth injuries. Journal of Hand Surgery (European Volume). 2023. DOI: 10.1177/17531934231196118

[46] A new surgical treatment for mallet finger deformity: Deepithelialised pedicled skin flap technique. Injury. 2013. DOI: 10.1016/j.injury.2013.01.013

[47] A Biomechanical Study of Distal Interphalangeal Joint Subluxation After Mallet Fracture Injury. The Journal of Hand Surgery. 2008. DOI: 10.1016/j.jhsa.2008.04.014

[51] Complications of Operative Treatment for Mallet Fractures of the Distal Phalanx. Journal of Hand Surgery. 2001. DOI: 10.1054/jhsb.2000.0440

[56] Mallet fingers with bone avulsion and DIP joint subluxation. Journal of Hand Surgery (European Volume). 2014. DOI: 10.1177/1753193414554772

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