Mallet Finger Workup

  • Author: Roy A Meals, MD; Chief Editor: Harris Gellman, MD   more...
 
Updated: Jul 1, 2011
 

Imaging Studies

Posteroanterior (PA) and lateral radiographs centered at the distal interphalangeal joint (DIPJ) of the affected finger are required, as shown below.

This x-ray depicts a large, dorsal-lip avulsion frThis x-ray depicts a large, dorsal-lip avulsion fracture from the distal phalanx, a bony mallet injury.

These radiographs are used to differentiate between a bony injury, as shown above, and a tendinous mallet injury, as well as reveal any associated metaphyseal, shaft, or tuft fractures of the distal phalanx. Perhaps most importantly, lateral radiographs reveal the presence of volar subluxation of the distal phalanx.

These radiographic views also reveal rare condylar fractures of the middle phalanx.

Radiographs of the whole hand do not suffice in evaluation of the mallet finger, as parallax of the x-ray beams creates an uninterpretable oblique view of the DIPJ.

No other imaging studies are indicated.

Proceed to Treatment & Management
 
 
Contributor Information and Disclosures
Author

Roy A Meals, MD  Clinical Professor, Department of Orthopedic Surgery, University of California at Los Angeles

Roy A Meals, MD is a member of the following medical societies: American Society for Surgery of the Hand

Disclosure: George Tiemann Company Royalty Other

Specialty Editor Board

Michael S Clarke, MD  Clinical Associate Professor, Department of Orthopedic Surgery, University of Missouri-Columbia School of Medicine

Michael S Clarke, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Academy of Pediatrics, American Association for Hand Surgery, American College of Surgeons, American Medical Association, Arthroscopy Association of North America, Clinical Orthopaedic Society, Mid-Central States Orthopaedic Society, and Missouri State Medical Association

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Thomas R Hunt III, MD  John D Sherrill Professor and Director of Orthopedic Surgery, Director of Hand and Upper Extremity Fellowship, University of Alabama at Birmingham School of Medicine; Surgeon-in-Chief, UAB Highlands Hospital

Thomas R Hunt III, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Association for Hand Surgery, American Orthopaedic Association, American Orthopaedic Society for Sports Medicine, American Society for Surgery of the Hand, AO Foundation, Mid-America Orthopaedic Association, and Southern Orthopaedic Association

Disclosure: Tornier Consulting fee Review panel membership; Tornier Royalty None; Tornier Ownership interest None; Lippincott Royalty Independent contractor

Dinesh Patel, MD, FACS  Associate Clinical Professor of Orthopedic Surgery, Harvard Medical School; Chief of Arthroscopic Surgery, Department of Orthopedic Surgery, Massachusetts General Hospital

Dinesh Patel, MD, FACS is a member of the following medical societies: American Academy of Orthopaedic Surgeons

Disclosure: Nothing to disclose.

Chief Editor

Harris Gellman, MD  Consulting Surgeon, Broward Hand Center; Voluntary Clinical Professor of Orthopedic Surgery and Plastic Surgery, Departments of Orthopedic Surgery and Surgery, University of Miami, Leonard M Miller School of Medicine

Harris Gellman, MD is a member of the following medical societies: American Academy of Medical Acupuncture, American Academy of Orthopaedic Surgeons, American Orthopaedic Association, American Society for Surgery of the Hand, and Arkansas Medical Society

Disclosure: Nothing to disclose.

References

  1. Husain SN, Dietz JF, Kalainov DM, Lautenschlager EP. A biomechanical study of distal interphalangeal joint subluxation after mallet fracture injury. J Hand Surg [Am]. Jan 2008;33(1):26-30. [Medline].

  2. Lubahn JD. Mallet finger fractures: a comparison of open and closed technique. J Hand Surg [Am]. Mar 1989;14(2 pt 2):394-6. [Medline].

  3. Wehbé MA, Schneider LH. Mallet fractures. J Bone Joint Surg Am. Jun 1984;66(5):658-69. [Medline]. [Full Text].

  4. 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. Jul 1997;79(4):544-7. [Medline]. [Full Text].

  5. Rayan GM, Mullins PT. Skin necrosis complicating mallet finger splinting and vascularity of the distal interphalangeal joint overlying skin. J Hand Surg [Am]. Jul 1987;12(4):548-52. [Medline].

  6. Kardestuncer T, Bae DS, Waters PM. The results of tenodermodesis for severe chronic mallet finger deformity in children. J Pediatr Orthop. Jan-Feb 2008;28(1):81-5. [Medline].

  7. Leibovic SJ. Arthrodesis of the interphalangeal joints with headless compression screws. J Hand Surg [Am]. Sep 2007;32(7):1113-9. [Medline].

  8. Rocchi L, Genitiempo M, Fanfani F. Percutaneous fixation of mallet fractures by the "umbrella handle" technique. J Hand Surg [Br]. Aug 2006;31(4):407-12. [Medline].

  9. Shin EK, Bae DS. Tenodermodesis for chronic mallet finger deformities in children. Tech Hand Up Extrem Surg. Dec 2007;11(4):262-5. [Medline].

  10. Teoh LC, Lee JY. Mallet fractures: a novel approach to internal fixation using a hook plate. J Hand Surg Eur Vol. Feb 2007;32(1):24-30. [Medline].

  11. Theivendran K, Mahon A, Rajaratnam V. A novel hook plate fixation technique for the treatment of mallet fractures. Ann Plast Surg. Jan 2007;58(1):112-5. [Medline].

  12. Ulusoy MG, Karalezli N, Koçer U, et al. Pull-in suture technique for the treatment of mallet finger. Plast Reconstr Surg. Sep 2006;118(3):696-702. [Medline].

  13. Stern PJ, Kastrup JJ. Complications and prognosis of treatment of mallet finger. J Hand Surg [Am]. May 1988;13(3):329-34. [Medline].

  14. Garberman SF, Diao E, Peimer CA. Mallet finger: results of early versus delayed closed treatment. J Hand Surg [Am]. Sep 1994;19(5):850-2. [Medline].

  15. Hussin P, Mahendran S, Ng ES. Chronic dislocation of proximal interphalangeal joint with mallet finger: A case report. Cases J. Oct 2 2008;1(1):201. [Medline].

  16. Jablecki J, Syrko M. Zone 1 extensor tendon lesions: current treatment methods and a review of literature. [Polish, English]. Ortop Traumatol Rehabil. Jan-Feb 2007;9(1):52-62. [Medline]. [Full Text].

 
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Despite active extension effort, the distal interphalangeal joint of the index finger rests in flexion, characteristic of a mallet finger.
This x-ray depicts a large, dorsal-lip avulsion fracture from the distal phalanx, a bony mallet injury.
A skin-tight plaster cast can effectively hold the distal interphalangeal joint extended and the proximal interphalangeal joint (PIP) flexed when a mallet deformity is accompanied by a hyperextensible PIP. Not immobilizing the PIP in partial flexion risks the development of a swan-neck deformity.
A stack splint is widely used for treatment of mallet finger.
Pressure-sore formation can result from a splint that is applied too tightly, especially if the joint is maintained in a hyperextended position rather than a position of neutral extension.
This photo demonstrates a thermoplastic blank for a custom-molded mallet finger splint and an oblique view of the molded splint in place.
Dorsal view of the custom-molded thermoplastic splint in place.
Volar view of the thermoplastic splint in place.
Video clip of splint application.
 
 
 
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