| Introduction |
 A finger deformity caused by disruption of the terminal extensor tendon distal to DIP joint
- the disruption may be bony or tendinous
- Mechanism
- traumatic impaction blow
- usually caused by a traumatic impaction blow to the tip of the finger in the extended position.
- forces the DIP joint into forced flexion
- dorsal laceration
- a less common mechanism of injury is a sharp or crushing-type laceration to the dorsal DIP joint
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| Presentation |
- Symptoms
- painful and swollen DIP joint following impaction injury to finger
- Physical exam
- fingertip rest at ~45° of flexion
- lack of active DIP extension
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| Imaging |
- Radiographs
- usually see bony avulsion of distal phalanx
- may be a ligamentous injury with normal bony anatomy
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| Treatment |
- Nonoperative
- extension splinting of DIP joint for 6-8 weeks
- indications
- acute soft tissue injury (< than 12 weeks)
- nondisplaced bony mallet injury
- technique
- maintain free movement of the PIP joint
- worn for 6-8 weeks
- volar splinting has less complications han dorsal splinting
- avoid hyperextension
- begin progressive flexion exercises at 6 weeks
- Operative
- CRPP vs ORIF
- indications
- absolute indications
- volar subluxation of distal phalanx
- relative indications
- >50% of articular surface involved
- >2mm articular gap
- technique
- simple pin fixation
- dorsal blocking pin
- surgical reconstruction of terminal tendon
- indications
- chronic injury (> 12 weeks) with healthy joint
- technique
- this may be done with direct repair/tendon advancement, tenodermodesis, or spiral oblique retinacular ligament reconstruction
- outcomes
- tendon reconstruction has a high complication rate (~ 50%)
- DIP arthrodesis
- indications
- painful, stiff, arthritic DIP joint
- Swan neck deformity correction
- indications
- Swan neck deformity present
- technique
- techniques to correct Swan neck deformity include
- lateral band tenodesis
- FDS tenodesis
- Fowler central slip tenotomy
- minimal Swan Neck deformities may correct with treatment of the DIP pathology alone
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| Complications |
- Extensor lag
- a slight residual extensor lag of < 10° may be present at completion of closed treatment
- Swan neck deformities
- occurs due to
- attenuation of volar plate and transverse retinacular ligament at PIP joint
- dorsal subluxation of lateral bands
- resulting PIP hyperextension
- contracture of triangular ligament maintains deformity
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Qbank (1 Questions)
Videos
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This video shows an ORIF of a bony mallet thumb using a Goal Post flap.
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12/22/2011
476 views
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Mallet Finger following basketball impaction injury to the middle finger.
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12/22/2011
418 views
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See More Videos
Groups
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Pegoli L, Toh S, Arai K, Fukuda A, Nishikawa S, Vallejo IG. The Ishiguro extension block technique for the treatment of mallet finger fracture: indications and clinical results. J Hand Surg Br. 2003 Feb;28(1):15- 7
PMID:12531661 (Link to Abstract)
Level of Evidence 5 and Other Journal Articles (includes Case Reports, Expert Opinions,
Personal Observations, and Biomechanic Studies)
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Theivendran K, Singh T, Rajaratnam V. Operative management of intra-articular distal interphalangeal joint fractures of the hand. Acta Orthop Belg. 2010 Aug;76(4):425-31.
PMID:20973346 (Link to Abstract)
Textbooks
- Review of Orthopaedics, 6th Edition, Mark D. Miller MD, Stephen R. Thompson MBBS MEd FRCSC, Jennifer Hart MPAS PA-C ATC, an imprint of Elsevier, Philadelphia, Copyright 2012
- AAOS Comprehensive Orthopaedic Review, Jay R. Leiberman. Published by American Academy of Orthopaedic Surgeons, Rosemont IL. Copyright 2009
- Orthopaedic Knowledge Update 10, John M Flyn. Published by American Academy of Orthopaedic Surgeons, Rosemont IL. Copyright 2011
- Hoppenfeld SP. Surgical Exposures in Orthopaedics: The Anatomic Approach. Lipponcott, Williams, and Wilkins, Philadelphia, PA, Copyright 2009
- Orthopaedic In-training Examination (OITE) Questions 2004-2012, American Academy of Orthopaedic Surgeons, Rosemont IL. Copyright 2004-2012
- Self-Assessment Examination (SAE) Questions 2004-2012, American Academy of Orthopaedic Surgeons, Rosemont IL. Copyright 2004-2012
Undefined
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Stern PJ, Kastrup JJ. Complications and prognosis of treatment of mallet finger. J Hand Surg Am. 1988 May;13(3):329-34. PubMed PMID: 3379263.
PMID:3379263 (Link to Abstract)
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