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Mallet Finger
From WikiSM
Contents
Other Names
- Extensor Avulsion Fracture
- Distal Extensor Tendon Rupture
Background
- Distal extensor tendon injury characterized by an inability to extend DIPJ
- Named for flexion deformity which resembles a mallet or hammer
- May be tendinous or bony
Pathophysiology
- Occurs when distal phalanx is forced into flexion while being actively extended
- May or may not include an osseus avulsion fracture
- Digits 3-5 most commonly affected (need reference)
- Etiology
- Acute, axial trauma
- Laceration
- Rarely, hyperextension of DIPJ
Risk Factors
- Ball sports where ball hits fingertip of extended finger
- Young middle aged males
- Older females
Differential Diagnosis
- Fractures
- Dislocations
- Tendon Injuries
- Ligament Injuries
- Neuropathies
- Arthropathies
- Pediatric Considerations
- Other
Clinical Features
- General: Physical Examination Hand
- Primarily a clinical diagnosis
- Patient may not always describe forced flexion
- Patient typically reports pain, flexion deformity, difficulty using finger
- Physical exam
- Fingertip typically resting at 45°
- Characterized by inability to extend DIPJ
- There may also be swelling and bruising
Evaluation
- Standard Radiographs Hand
- Role of US, MRI unclear
Classification
Doyle’s Classification of Mallet Finger Injuries
- Grade 1: Closed injury, with or without small dorsal avulsion fracture[1]
- Grade 2: Open injury (laceration)
- Grade 3: Open injury (deep abrasion involving skin and tendon)
- Grade 4: Mallet fracture
- A: distal phalanx physeal fracture (pediatrics)
- B: fracture fragment involving 20-50% articular surface
- C: fracture fragment involving >50% articular surface
Management
Nonoperative
- Indications:
- Acute <12 weeks
- Closed
- <1/3 of articular surface
- No associated DIP subluxation
- Typically immobilize DIPJ only in extension splint
- Including Stack Splint, thermoplastic splint, aluminum-foam splint
- Duration usually 6-8 weeks
Operative
- Indications:
- >1/3 articular surface involved
- Joint subluxation
- Open fracture
- Typically immobilized with a K-wire
Return to Play
- Needs to be updated
- Splint typically work for 6-8 weeks
Complications
- Swan Neck Deformity
- Extensor lag
See Also
External
- Sports Med Review Hand Pain: https://www.sportsmedreview.com/by-joint/hand/
References
- ↑ Lin JS, Samora JB. Surgical and Nonsurgical Management of Mallet Finger: A Systematic Review. J Hand Surg Am. 2018 Feb;43(2):146-163.e2.
Created by:
John Kiel on 18 June 2019 23:17:05
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Last edited:
16 October 2022 00:19:08
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