summary Mallet Finger is a finger deformity caused by disruption of the terminal extensor tendon distal to DIP joint Diagnosis is made clinically with a presence of a distal phalanx that rests at ~45° of flexion with lack of active DIP extension. Treatment is usually extension splinting of DIP joint for 6-8 weeks. Surgical management is indicated for volar subluxation of the distal phalanx, chronic injuries, or with the presence of significant arthritis. 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 Anatomic location most frequently involves long, ring and small fingers of dominant hand Etiology 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 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) Presentation 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 Imaging Radiographs findings usually see bony avulsion of distal phalanx may be a ligamentous injury with normal bony anatomy Treatment Nonoperative extension splinting of DIP joint for 6-8 weeks for 24 hours daily indications acute soft tissue injury (< than 12 weeks) small or minimally displaced bony mallet injury without joint subluxation 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 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 Techniques 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 minimal Swan Neck deformities may correct with treatment of the DIP pathology alone Complications Extensor lag a slight residual extensor lag of < 10° may be present at completion of closed treatment, however, no functional deficit. 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
QUESTIONS 1 of 4 1 2 3 4 Previous Next (OBQ18.211) A 30-year-old woman sustains an acute injury to her right long finger while building new cabinets in her kitchen. On exam, she has pain and swelling at the distal interphalangeal (DIP) joint and lacks active DIP extension. Figure A is her current radiograph. What is the next best step in treatment? QID: 213107 FIGURES: A Type & Select Correct Answer 1 Extension splinting of DIP joint 24 hours daily for 6-8 weeks 79% (1823/2308) 2 Extension splinting of DIP joint 12 hours daily for 6-8 weeks 2% (36/2308) 3 Extension splinting of DIP joint 24 hours daily for 2-4 weeks 15% (356/2308) 4 Extension splinting of DIP joint 12 hours daily for 2-4 weeks 2% (50/2308) 5 Extension splinting of PIP joint 24 hours daily for 6-8 weeks 1% (32/2308) L 2 Question Complexity A Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 1 Review Tested Concept Review Full Topic (OBQ12.2) A 42-year-old sustains a left finger injury while attempting to catch a baseball for his son. He presents with left, long finger pain and an inability to extend his middle finger at the distal interphalangeal joint. A radiograph after closed reduction and splinting is shown in Figure A. What is the best course of treatment? QID: 4362 FIGURES: A Type & Select Correct Answer 1 Reduction and pinning 89% (6729/7566) 2 Repeat splinting of the distal interphalangeal joint in extension 6% (438/7566) 3 Splinting of the distal and proximal interphalangeal joints in extension 3% (259/7566) 4 Observation 0% (36/7566) 5 Fusion of the distal interphalangeal joint 0% (29/7566) L 1 Question Complexity B Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 1 Review Tested Concept Review Full Topic (OBQ12.85) A 27-year-old male presents with finger pain 2 days after suffering an injury while playing basketball. Physical exam shows swelling of the distal interphalangeal joint with no evidence of open injury. A radiograph is shown in Figure A. Which of the following is the most appropriate treatment at this time? QID: 4445 FIGURES: A Type & Select Correct Answer 1 Extension splinting of DIP joint for 6-8 weeks 91% (6132/6764) 2 Closed reduction and percutaneous pinning 7% (444/6764) 3 Open reduction and internal fixation 2% (124/6764) 4 DIP arthrodesis 0% (16/6764) 5 Swan neck deformity correction 0% (7/6764) L 1 Question Complexity B Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 1 Review Tested Concept Review Full Topic Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK
All Videos (3) Podcasts (1) Login to View Community Videos Login to View Community Videos Bony Mallet Finger Treatment - Closed Extension-Block Pinning Kemal Gokkus Hand - Mallet Finger 2/20/2023 66 views 0.0 (0) Login to View Community Videos Login to View Community Videos Mallet Finger (Baseball Finger ) Kemal Gokkus Hand - Mallet Finger A 10/19/2019 1837 views 4.7 (7) Login to View Community Videos Login to View Community Videos ORIF of Bony Mallet Thumb - Anonymous Hand - Mallet Finger B 12/22/2011 8925 views 5.0 (21) Hand⎪Mallet Finger Hand - Mallet Finger Listen Now 12:14 min 8/24/2020 496 plays 5.0 (1)
Azienda Ospedaliero Universitaria Sassari Ring Finger Mallet Fx in 22M (C2346) Andrea Cassisa Hand - Mallet Finger B 9/11/2015 10230 12 16