Mallet Fracture Treatment & Management
- Author: Michael E Robinson, MD; Chief Editor: Craig C Young, MD more...
Acute Phase
Rehabilitation Program
Physical Therapy
Treatment of the tendinous mallet finger or stable mallet fracture (see image below) consists of splinting the DIP joint in full extension for 6 weeks[1, 3, 5, 6, 7] ; the PIP joint is allowed full motion. After 6 weeks, active range of motion (ROM) may be initiated. To ensure maximum tendon stability, most authors recommend an additional 2 weeks of night splinting and up to 8 weeks of splinting during athletic activities that may place the finger at risk of reinjury.
Stable mallet fracture that involves 40% of the joint surface. Splinting can be accomplished with the use of an aluminum foam splint (see first image below) that is placed either on the dorsal or volar surface of the finger and taped to hold the DIP joint in extension. Molded plastic splints (see second image below) that have been designed specifically for the treatment of mallet injuries are commercially available.
Dorsal aluminum foam splint for the treatment of a mallet finger. 
Molded plastic splint for the treatment of a mallet finger. Most athletes with mallet finger are able to participate in their sport during treatment. Additional padding and support of the affected finger may be appropriate for play in contact sports. Throwing athletes who injure their dominant hand may initially miss practice and playing time.
Instructing the patient in proper splint care and compliance is essential. Splints may be changed to allow for skin cleansing and drying, but the DIP joint must remain continuously in extension. Any flexion event may adversely affect the outcome.
Medical Issues/Complications
Caution should be used when positioning the involved DIP joint during splinting. Excessive hyperextension or excessive dorsal pressure over the joint may compromise circulation and lead to skin necrosis.
Related eMedicine topics:
Pressure Ulcers, Nonsurgical Treatment and Principles
Pressure Ulcers and Wound Care
Related Medscape topic:
Resource Center Wound Management
Surgical Intervention
The appropriate indications for surgical fixation of mallet fractures, which techniques to use, and the accuracy of outcome measures are frequently debated.[1, 5, 8, 9] Most authors agree that mallet fractures that are associated with volar subluxation of the distal phalange should be referred to an orthopedic surgeon for fixation. Referral should also be considered for cases in which there are large or displaced avulsion fragments that involve more than 30-40% of the joint surface.[8] Surgical fixation of a mallet fracture of the thumb is sometimes recommended due to the greater extrinsic displacing forces across the IP joint.
Related Medscape topics:
Resource Center Fracture
Resource Center Joint Disorders
Specialty Site Orthopaedics
Specialty Site Surgery
Tuttle HG, Olvey SP, Stern PJ. Tendon avulsion injuries of the distal phalanx. Clin Orthop Relat Res. Apr 2006;445:157-68. [Medline].
Browner BD, Jupiter JB, Levine AM, Trafton PG, eds. Skeletal Trauma: Fractures, Dislocations, Ligamentous Injuries. Philadelphia, Pa: WB Saunders Co; 1992.
Wang QC, Johnson BA. Fingertip injuries. Am Fam Physician. May 15 2001;63(10):1961-6. [Medline]. [Full Text].
Anderson D. Mallet finger - management and patient compliance. Aust Fam Physician. Jan-Feb 2011;40(1-2):47-8. [Medline].
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].
Simpson D, McQueen MM, Kumar P. Mallet deformity in sport. J Hand Surg [Br]. Feb 2001;26(1):32-3. [Medline].
Smit JM, Beets MR, Zeebregts CJ, Rood A, Welters CF. Treatment options for mallet finger: a review. Plast Reconstr Surg. Nov 2010;126(5):1624-9. [Medline].
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].
Hoffman DF, Schaffer TC. Management of common finger injuries. Am Fam Physician. May 1991;43(5):1594-607. [Medline].
Leibovic SJ. Arthrodesis of the interphalangeal joints with headless compression screws. J Hand Surg [Am]. Sep 2007;32(7):1113-9. [Medline].
Peterson JJ, Bancroft LW. Injuries of the fingers and thumb in the athlete. Clin Sports Med. Jul 2006;25(3):527-42, vii-viii. [Medline].
Rettig AC. Epidemiology of hand and wrist injuries in sports. Clin Sports Med. Jul 1998;17(3):401-6. [Medline].
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].
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].
Print
