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Home » Features » Ortho Dx

ORTHODX: CHRONIC MALLET FINGER

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FIGURE 2. PHOTOGRAPH TAKEN 1 MONTH AFTER REMOVING SPLINT.

FIGURE 1. LATERAL RADIOGRAPH OF MALLET FINGER AFFECTING THE MIDDLE FINGER.

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FIGURE 2. PHOTOGRAPH TAKEN 1 MONTH AFTER REMOVING SPLINT.

FIGURE 1. LATERAL RADIOGRAPH OF MALLET FINGER AFFECTING THE MIDDLE FINGER.

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FIGURE 2. PHOTOGRAPH TAKEN 1 MONTH AFTER REMOVING SPLINT.

* CASE STUDY:

* EXPLANATION:

A 34-year-old man presents 3 months after being treated for mallet finger to his
right third finger. Lateral radiograph of the finger at the time of injury is
shown in Figure 1. He was treated with an extension splint for 6 weeks followed
by nighttime splinting for an additional 2 weeks. When he took the splint off
last month, the deformity returned. He is now unable to extend the distal
phalanx and has an approximately 45° flexion deformity to the distal
interphalangeal joint (DIP) joint (Figure 2).

Submit your diagnosis to see full explanation.

Mallet finger is a disruption of the terminal extensor tendon where it attaches
to the dorsal distal phalanx. The extensor tendon can avulse a piece of bone off
(bony mallet) or be purely a soft tissue avulsion.1 The injury occurs as a
result of a sudden forced flexion to the DIP joint.2 Treatment of acute mallet
finger includes extension splinting of the DIP joint for 6 to 8 weeks. Residual
extensor lag of 20° or less after treatment is considered a satisfactory
outcome.2,3

Mallet finger presenting 4 weeks after injury (from either benign neglect or
failed treatment) is considered to be a chronic injury. Extension splinting is
recommended for treating chronic injuries and has a similar success rate to
treatment of acute injuries. Surgical repair is reserved after failure of
nonoperative treatment. A complication of mallet deformity may include the
formation of a swan-neck deformity caused by compensatory hyperextension at the
PIP joint.3

Dagan Cloutier, MPAS, PA-C, practices in a multispecialty orthopedic group in
the southern New Hampshire region and is editor in chief of the Journal of
Orthopedics for Physician Assistants.

REFERENCES

1. Alla SR, Deal ND, Dempsey IJ. Current concepts: mallet finger. Hand.
2014;9(2):138-144. doi:10.1007/s11552-014-9609-y

2. Bendre AA, Hartigan BJ, Kalainov DM. Mallet finger. J Am Acad Orthop Surg.
2005;13(5):336-344. doi:10.5435/00124635-200509000-00007

3. Okafor B, Mbubaegbu C, Munshi I, Williams DJ. Mallet deformity of the finger:
five-year follow-up of conservative treatment. J Bone Joint Surg Br.
1997;79(4):544-547. doi:10.1302/0301-620x.79b4.7432

QUESTION

What is the next step in treatment?
* Observation, further treatment is unlikely to improve the deformity
* Repeat extension splinting for 8 to 10 weeks
* Percutaneous pinning of the DIP joint
* DIP joint fusion

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