Mallet Finger

Commonly an athletic injury, mallet finger occurs when the distal phalanx of the finger is injured. Basketball and netball players often experience jammed fingers, but the injury can occur because of a crushing accident or even because of a laceration to the finger.

With mallet finger, the extensor tendon on the back of the finger (dorsum) is separated from the muscles it connects.

Three types of injuries commonly occur:

  • The tendon is damaged, but no are present.
  • The tendon ruptures with an avulsion fracture caused by the force of the injury.
  • The tendon ruptures with a large fracture.

Mallet Finger Symptoms

Patient is unable to extend at the DIPJ

People with mallet finger may delay seeking medical attention – even though they may be in a great deal of pain – simply because they can still use their hand.

Symptoms may include the following:

  • Pain, tenderness, and swelling at the outermost joint (DIPJ) immediately after the injury
  • Swelling and redness soon after the injury
  • Inability to completely extend the finger at the DIPJ while still being able to move it with help.

To X-Ray or Not X-Ray

Some patient’s won’t have bony tenderness, however if they have a mallet deformity I would still x-ray. These patient’s will go going to Virtual Fracture Clinic and T & O will want to see images of the finger.

Mallet fingers often have a small avulsion fracture to the proximal portion to the dorsal aspect of the distal phalanx on the affected finger. A similar injury can be seen on this x-ray.

Treatment

Most mallet finger injuries are treated with splinting. A splint holds the fingertip straight (in extension) until it heals.

To restore function to the finger, the splint must be worn full time for 8 weeks. This means that it must be worn at all times, with special care taken when removing to clean etc. The patient must keep their injured finger straight. If the fingertip droops at all, healing is disrupted and they will need to wear the splint for a longer period of time.

The ED treatment required is:

  •   Analgesia, especially NSAIDS
  •  Mallet splint
  • Virtual fracture clinic appointment
  • Explanation of how to remove the replace the Mallet splint

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