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Mallet Finger

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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


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


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


See Also


References


  1. 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
Authors:
Last edited:
28 October 2020 13:59:10
Categories:
Tendinopathies | Trauma | Finger | Hand | Upper Extremity | Acute