Mallet Finger


MECHANISM

DEFORMITY

TREATMENT

  Initial Treatment
Splint type & position Dorsal padded aluminum splint, volar splint, stack splint
DIP joint in slight hyperextension
Initial follow-up visit  2 wks
Pt instructions Do not attempt to flex DIP joint
Get assistance with changing or retaping splint
  Follow-up Care
Cast or Splint type & position Same as above
Length of immobilization 6-8 wks followed by 2-3 wks of night time only splinting
Healing time 8-10 wks
Follow-up visit interval Every 2 wks
Assess compliance with continuous splinting
Repeat radiography interval 6 wks after injury
Every 1 to 2 months if the patient remains symptomatic
Pt instruction Must keep DIP joint extension at all times
Do not attempt to flex DIP joint
Indications for orthopedic consult Volar displacement of distal phalanx
Consider for displaced or more than 30% articular involvement
Late mallet deformity after failed attempt at splinting
Swan-neck deformity
Inability to passively extend DIP

Return to Work or Sports

 




ITE 2013, Q#117.
An 18-year-old basketball player comes to your office for evaluation of finger pain. During a basketball game yesterday he was hit on the tip of his right second digit and now has finger pain and difficulty moving his finger. On examination he has bruising and tenderness over the distal interphalangeal (DIP) joint. His DIP joint is in the flexed position and he is unable to extend the joint. A radiograph shows a fracture at the dorsal surface of the proximal distal phalanx involving 10% of the joint space.
What is the most appropriate management of this injury?

A) Taping the finger to the adjacent finger
B) Splinting in full extension
C) Splinting in 45° of flexion
D) Urgent surgical management
E) Intermittent splinting for comfort

ANSWER: B