https://upload.orthobullets.com/topic/6014/images/Xray - lateral_moved.jpg
  • A finger deformity caused by disruption of the terminal extensor tendon distal to DIP joint
    • the disruption may be bony or tendinous
  • Epidemiology
    • risk factors
      • usually occur in the work environment or during participation in sports
    • demographics
      • common in young to middle-aged males and older females
    • body location
      • most frequently involves long, ring and small fingers of dominant hand
  • Pathophysiology
    • mechanism of injury
      • traumatic impaction blow
        • usually caused by a traumatic impaction blow (i.e. sudden forced flexion) 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
  • Doyle's Classification 
Doyle's Classification of Mallet Finger Injuries
Type I
 • Closed injury with or without small dorsal avulusion fracture
Type II
 • Open injury (laceration)
Type III
 • Open injury (deep soft tissue abrasion involving loss skin and tendon substance)
Type IV

 • Mallet fracture 
A = distal phalanx physeal injury (pediatrics)
B = fracture fragment involving 20% to 50% of articular surface (adult)
C = fracture fragment >50% of articular surface (adult)

  • Symptoms
    • primary symptoms
      • painful and swollen DIP joint following impaction injury to finger 
        •  often in ball sports
  • Physical exam
    • inspection
      • fingertip rest at ~45° of flexion
    • motion
      • lack of active DIP extension
  • Radiographs
    • findings
      • usually see bony avulsion of distal phalanx 
      • may be a ligamentous injury with normal bony anatomy
  • 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 than dorsal splinting
        • avoid hyperextension
        • begin progressive flexion exercises at 6 weeks
  • Operative 
    • CRPP vs ORIF post
      • indications
        • absolute indications 
          • volar subluxation of distal phalanx
        • relative indications
          • >50% of articular surface involved
          • >2mm articular gap
    • surgical reconstruction of terminal tendon
      • indications
        • chronic injury (> 12 weeks) with healthy joint
      • 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
  • CRPP vs ORIF
    • approach
      • dorsal midline incision
    • fixation
      • simple pin fixation
      • dorsal blocking pin 
  • Surgical reconstruction of terminal tendon
    • repair
      • this may be done with direct repair/tendon advancement, tenodermodesis, or spiral oblique retinacular ligament reconstruction
  • Swan neck deformity correction
    • techniques to correct Swan neck deformity include
      • lateral band tenodesis
      • FDS tenodesis
      • Fowler central slip tenotomy
        • for deformities of <35° extensor lag
      • minimal Swan Neck deformities may correct with treatment of the DIP pathology alone
  • 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

Please rate topic.

Average 4.3 of 39 Ratings

Questions (4)
Topic COMMENTS (13)
Private Note