Sections

Workup

Radiography

Posteroanterior (PA) and lateral radiographs centered at the distal interphalangeal (DIP) joint of the affected finger are required. These radiographs are used to differentiate between a bony mallet injury (see the first image below) and a tendinous one. They also reveal any associated metaphyseal, shaft, or tuft fractures of the distal phalanx. Perhaps most important, lateral radiographs reveal the presence of volar subluxation of the distal phalanx (see the second image below). In addition, these radiographic views reveal rare condylar fractures of the middle phalanx.

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

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$Mallet fracture with volar subluxation of the dist$ Mallet fracture with volar subluxation of the distal phalanx.

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Radiographs of the whole hand do not suffice in the evaluation of mallet finger, because parallax of the x-ray beams creates an uninterpretable oblique view of the DIP joint. No imaging studies other than radiography are indicated in mallet finger.

Treatment & Management

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Media Gallery

Despite active extension effort, the distal interphalangeal joint of the index finger rests in flexion, characteristic of a mallet finger.
Typical mallet finger deformity.
This radiograph depicts a large, dorsal-lip avulsion fracture from the distal phalanx, a bony mallet injury.
Mallet fracture with volar subluxation of the distal phalanx.
Stable mallet fracture that involves 40% of the joint surface.
Dorsal aluminum foam splint for the treatment of a mallet finger.
Stack splints are widely used for the treatment of mallet finger.
Molded plastic stack splint for the treatment of mallet finger.
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.
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.
Application of the thermoplastic splint.

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Author

Roy A Meals, MD Clinical Professor, Department of Orthopedic Surgery, University of California, Los Angeles, David Geffen School of Medicine

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

Disclosure: Received royalty from George Tiemann Company for other.

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; Clinical Professor of Surgery, Nova Southeastern 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, Arkansas Medical Society, Florida Medical Association, Florida Orthopaedic Society

Disclosure: Nothing to disclose.

Acknowledgements

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.

Henry T Goitz, MD Academic Chair and Associate Director, Detroit Medical Center Sports Medicine Institute; Director, Education, Research, and Injury Prevention Center; Co-Director, Orthopaedic Sports Medicine Fellowship

Henry T Goitz, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons and American Orthopaedic Society for Sports Medicine

Disclosure: Nothing to disclose.

Thomas R Hunt III, MD Professor and Chairman, Joseph Barnhart Department of Orthopedic Surgery, Baylor College of Medicine

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 Royalty Independent contractor; Tornier Ownership interest None; Lippincott Royalty Independent contractor

Michael E Robinson, MD Consulting Staff, Department of Orthopedics, Division of Primary Care Sports Medicine, Permanente Medical Group and Kaiser Hospital

Michael E Robinson, MD is a member of the following medical societies: American Medical Society for Sports Medicine

Disclosure: Nothing to disclose.

Anthony J Saglimbeni, MD President, South Bay Sports and Preventive Medicine Associates; Private Practice; Team Internist, San Francisco Giants; Team Internist, West Valley College; Team Physician, Bellarmine College Prep; Team Physician, Presentation High School; Team Physician, Santa Clara University; Consultant, University of San Francisco, Academy of Art University, Skyline College, Foothill College, De Anza College

Anthony J Saglimbeni, MD, is a member of the following medical societies: California Medical Association and Santa Clara County Medical Association

Disclosure: South Bay Sports and Preventive Medicine Associates, Inc Ownership interest Other

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

Craig C Young, MD Professor, Departments of Orthopedic Surgery and Community and Family Medicine, Medical Director of Sports Medicine, Director of Primary Care Sports Medicine Fellowship, Medical College of Wisconsin

Craig C Young, MD is a member of the following medical societies: American Academy of Family Physicians, American College of Sports Medicine, American Medical Society for Sports Medicine, and Phi Beta Kappa

Disclosure: Nothing to disclose.

Mallet Finger Workup

Radiography

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