April 11, 2024

Mallet finger occurs due to disruption of terminal extensor tendon results in DIP joint extension lag which is called Baseball finger

Mallet finger
Mallet finger

Etiology

A forceful blow to the tip of the finger causes Sudden flexion over the DIP

Hyperextension injuries with fracture of the dorsal lip of dorsal phalanx

Classification of Mallet finger

TypeFeatures
Type 1Most common
Close blunt trauma with loss of tendon continuity with/ without small avulsion fracture
Type 2Laceration at or proximal to DIP and loss of tendon continuity
Type 3Deep avulsion with loss of skin, subcutaneous cover, and tendon substances
Type 4ATransphyseal fracture in children
Type 4BHyperflexion injury with fracture of the articular surface (20%-50%)
Type 4CHyperflexion injury with fracture of the articular surface (>50%) with early or late volar subluxation of the distal phalanx

Treatment Options according to classification

Type 1

Continuous DIP extension splint (6-8 weeks), then night splinting for (2-6 weeks) additional

Volar or dorsal splint

Hyperextension of the distal IP joint avoided because it causes skin balancing and breakdown

Type 2

Close reduction after appropriate wound care

Splint management may be difficult due to wounds so direct repair of extensor tendon with K-Wire fixation of DIP Joint in full extension

Type 3

Require soft tissue coverage and pinning of DIP joint

Possible arthrodesis

Child Mallet finger (Seymour fracture)

Closed reduction of DIP in slight extension (4 weeks)

If close reduction cannot be obtained, OR with K-wire fixation for epiphyseal fragment

Type 4B/4C

Operative treatment is associated with numerous complications

  • Infections
  • Nail deformity
  • Tender pulp scan
  • Loss of reduction and fixation

Nonoperative extension splint

For Fracture: > 1/3rd of the articular surface. OR using pull-out wire + Transarticular K-wire in extension is advised

Chronic mallet finger: Painful condition so better go for arthrodesis