Current Concepts: Mallet Finger

Abstract

Loss of the extensor mechanism at the distal interphalangeal (DIP) joint leads to mallet finger also known as baseball finger or drop finger. This can be secondary to tendon substance disruption or to a bony avulsion. Soft tissue mallet finger is the result of a rupture of the extensor tendon in Zone 1, and a bony mallet finger is the result of an avulsion of the extensor tendon from the distal phalanx with a small fragment of bone attached to the avulsed tendon. Mallet finger leads to an imbalance in the distribution of the extensor force between the proximal interphalangeal (PIP) and DIP joints. If left untreated, mallet finger leads to a swan neck deformity from PIP joint hyper extension and DIP joint flexion. Most mallet finger injuries can be managed non-surgically, but occasionally surgery is recommended for either an acute or a chronic mallet finger or for salvage of failed prior treatment.

Extension Block Pinning Versus Hook Plate Fixation for Treatment of Mallet Fractures

“…21 However, according to some reports, fractures that involve 30% to 50% of the joint surface are considered unstable and require surgery. 22 A lateral x-ray view should be carefully evaluated because large fractures do not always lead to subluxation and instability. At our institution we treat soft tissue injuries using closed methods and all bony mallet injuries involving greater than one third of the articular surface with surgery.…”

Phalangeal fractures in children

“…Ova vrsta prijeloma nastaje zbog aksijalnog opterećenja na ispruženi prst (13), što za posljedicu ima avulzijski prijelom hvatišta ekstenzorne tetive na epifizi, čime se taj prijelom može kategorizirati kao unutarzglobni (14). Većina ovih prijeloma može se liječiti konzervativnim mjerama, i to sa šest do osam tjedana kontinuirane imobilizacije za distalni interfalangealni (DIP) zglob, uz dodatna dva do četiri tjedna istovrsne imobilizacije tijekom noći i tijekom športskih aktivnosti (15).…”

Comparison Between Y- and S-Shaped Incisions for Open Reduction and Hook-Plate Fixation of the Mallet Finger

“…It is called soft-tissue mallet finger if it is caused due to extensor tendon rupture at zone I and osseous mallet finger if it is caused by bony avulsion of the extensor tendon. Osseous mallet finger is usually seen in young and middle-aged male patients and in approximately 74% of cases, the dominant hand is affected (1,2).…”

“…Splint usage is believed to be effective in the treatment of minimally displaced or soft-tissue mallet finger; however, if there is more than 3 mm excursion of the extensor tendon, extensor lag or bump formation at the dorsal part of the finger can be seen as complications (1,(4)(5)(6)(7). Surgical treatment is recommended if there is volar subluxation, mostly due to the bony fragment including >50% of the joint surface, dorsal bony fragment which include >30% of the joint surface or >3 mm of displacement, failed previous treatment, and open injuries (2,(8)(9)(10). The most frequent sequels of the neglected mallet finger are extensor lag, a prominent bump on the dorsal surface of the finger, and swan neck deformity (2).…”

“…Surgical treatment is recommended if there is volar subluxation, mostly due to the bony fragment including >50% of the joint surface, dorsal bony fragment which include >30% of the joint surface or >3 mm of displacement, failed previous treatment, and open injuries (2,(8)(9)(10). The most frequent sequels of the neglected mallet finger are extensor lag, a prominent bump on the dorsal surface of the finger, and swan neck deformity (2).…”